|
HC DRSNG TEGADERM CHG IV 2.75X3.375"
|
Facility
|
OP
|
$42.48
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$38.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.10
|
| Rate for Payer: Blue Distinction Transplant |
$25.49
|
| Rate for Payer: Blue Shield of California Commercial |
$26.72
|
| Rate for Payer: Blue Shield of California EPN |
$20.77
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Central Health Plan Commercial |
$33.98
|
| Rate for Payer: Cigna of CA HMO |
$27.19
|
| Rate for Payer: Cigna of CA PPO |
$31.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.11
|
| Rate for Payer: Dignity Health Media |
$36.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.99
|
| Rate for Payer: Galaxy Health WC |
$36.11
|
| Rate for Payer: Global Benefits Group Commercial |
$25.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$31.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Multiplan Commercial |
$31.86
|
| Rate for Payer: Networks By Design Commercial |
$27.61
|
| Rate for Payer: Prime Health Services Commercial |
$36.11
|
| Rate for Payer: Riverside University Health System MISP |
$16.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.24
|
| Rate for Payer: United Healthcare All Other HMO |
$21.24
|
| Rate for Payer: United Healthcare HMO Rider |
$21.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.11
|
| Rate for Payer: Vantage Medical Group Senior |
$36.11
|
|
|
HC DRSNG TEGADERM CHG IV 2.75X3.375"
|
Facility
|
IP
|
$42.48
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$38.23 |
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Central Health Plan Commercial |
$33.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.99
|
| Rate for Payer: Galaxy Health WC |
$36.11
|
| Rate for Payer: Global Benefits Group Commercial |
$25.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.50
|
| Rate for Payer: Multiplan Commercial |
$31.86
|
| Rate for Payer: Networks By Design Commercial |
$27.61
|
| Rate for Payer: Prime Health Services Commercial |
$36.11
|
|
|
HC DRSNG TEGADERM CHG IV 3.5X4.5"
|
Facility
|
OP
|
$44.94
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$40.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Distinction Transplant |
$26.96
|
| Rate for Payer: Blue Shield of California Commercial |
$28.27
|
| Rate for Payer: Blue Shield of California EPN |
$21.98
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Central Health Plan Commercial |
$35.95
|
| Rate for Payer: Cigna of CA HMO |
$28.76
|
| Rate for Payer: Cigna of CA PPO |
$33.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: Dignity Health Media |
$38.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.98
|
| Rate for Payer: Galaxy Health WC |
$38.20
|
| Rate for Payer: Global Benefits Group Commercial |
$26.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.99
|
| Rate for Payer: Multiplan Commercial |
$33.70
|
| Rate for Payer: Networks By Design Commercial |
$29.21
|
| Rate for Payer: Prime Health Services Commercial |
$38.20
|
| Rate for Payer: Riverside University Health System MISP |
$17.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.47
|
| Rate for Payer: United Healthcare All Other HMO |
$22.47
|
| Rate for Payer: United Healthcare HMO Rider |
$22.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.20
|
| Rate for Payer: Vantage Medical Group Senior |
$38.20
|
|
|
HC DRSNG TEGADERM CHG IV 3.5X4.5"
|
Facility
|
IP
|
$44.94
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$40.45 |
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Central Health Plan Commercial |
$35.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.98
|
| Rate for Payer: Galaxy Health WC |
$38.20
|
| Rate for Payer: Global Benefits Group Commercial |
$26.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.99
|
| Rate for Payer: Multiplan Commercial |
$33.70
|
| Rate for Payer: Networks By Design Commercial |
$29.21
|
| Rate for Payer: Prime Health Services Commercial |
$38.20
|
|
|
HC DRSNG TEGADERM CHG IV 4X6 1/8"
|
Facility
|
IP
|
$49.61
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Central Health Plan Commercial |
$39.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.84
|
| Rate for Payer: Galaxy Health WC |
$42.17
|
| Rate for Payer: Global Benefits Group Commercial |
$29.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.92
|
| Rate for Payer: Multiplan Commercial |
$37.21
|
| Rate for Payer: Networks By Design Commercial |
$32.25
|
| Rate for Payer: Prime Health Services Commercial |
$42.17
|
|
|
HC DRSNG TEGADERM CHG IV 4X6 1/8"
|
Facility
|
OP
|
$49.61
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.31
|
| Rate for Payer: Blue Distinction Transplant |
$29.77
|
| Rate for Payer: Blue Shield of California Commercial |
$31.20
|
| Rate for Payer: Blue Shield of California EPN |
$24.26
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Central Health Plan Commercial |
$39.69
|
| Rate for Payer: Cigna of CA HMO |
$31.75
|
| Rate for Payer: Cigna of CA PPO |
$36.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.17
|
| Rate for Payer: Dignity Health Media |
$42.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.84
|
| Rate for Payer: Galaxy Health WC |
$42.17
|
| Rate for Payer: Global Benefits Group Commercial |
$29.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.92
|
| Rate for Payer: Multiplan Commercial |
$37.21
|
| Rate for Payer: Networks By Design Commercial |
$32.25
|
| Rate for Payer: Prime Health Services Commercial |
$42.17
|
| Rate for Payer: Riverside University Health System MISP |
$19.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.80
|
| Rate for Payer: United Healthcare All Other HMO |
$24.80
|
| Rate for Payer: United Healthcare HMO Rider |
$24.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.17
|
| Rate for Payer: Vantage Medical Group Senior |
$42.17
|
|
|
HC DRSNG TEGADERM IV PORT
|
Facility
|
IP
|
$9.02
|
|
| Hospital Charge Code |
901607829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: Central Health Plan Commercial |
$7.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.61
|
| Rate for Payer: Galaxy Health WC |
$7.67
|
| Rate for Payer: Global Benefits Group Commercial |
$5.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.76
|
| Rate for Payer: Networks By Design Commercial |
$5.86
|
| Rate for Payer: Prime Health Services Commercial |
$7.67
|
|
|
HC DRSNG TEGADERM IV PORT
|
Facility
|
OP
|
$9.02
|
|
| Hospital Charge Code |
901607829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$8.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.33
|
| Rate for Payer: Blue Distinction Transplant |
$5.41
|
| Rate for Payer: Blue Shield of California Commercial |
$5.67
|
| Rate for Payer: Blue Shield of California EPN |
$4.41
|
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: Central Health Plan Commercial |
$7.22
|
| Rate for Payer: Cigna of CA HMO |
$5.77
|
| Rate for Payer: Cigna of CA PPO |
$6.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.67
|
| Rate for Payer: Dignity Health Media |
$7.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.61
|
| Rate for Payer: Galaxy Health WC |
$7.67
|
| Rate for Payer: Global Benefits Group Commercial |
$5.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.76
|
| Rate for Payer: Networks By Design Commercial |
$5.86
|
| Rate for Payer: Prime Health Services Commercial |
$7.67
|
| Rate for Payer: Riverside University Health System MISP |
$3.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.67
|
| Rate for Payer: Vantage Medical Group Senior |
$7.67
|
|
|
HC DRSNG TEGADERM PICC/CVC IV 3.5X4.5"
|
Facility
|
IP
|
$69.95
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: Central Health Plan Commercial |
$55.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.98
|
| Rate for Payer: Galaxy Health WC |
$59.46
|
| Rate for Payer: Global Benefits Group Commercial |
$41.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.99
|
| Rate for Payer: Multiplan Commercial |
$52.46
|
| Rate for Payer: Networks By Design Commercial |
$45.47
|
| Rate for Payer: Prime Health Services Commercial |
$59.46
|
|
|
HC DRSNG TEGADERM PICC/CVC IV 3.5X4.5"
|
Facility
|
OP
|
$69.95
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.33
|
| Rate for Payer: Blue Distinction Transplant |
$41.97
|
| Rate for Payer: Blue Shield of California Commercial |
$44.00
|
| Rate for Payer: Blue Shield of California EPN |
$34.21
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: Central Health Plan Commercial |
$55.96
|
| Rate for Payer: Cigna of CA HMO |
$44.77
|
| Rate for Payer: Cigna of CA PPO |
$51.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.46
|
| Rate for Payer: Dignity Health Media |
$59.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.98
|
| Rate for Payer: Galaxy Health WC |
$59.46
|
| Rate for Payer: Global Benefits Group Commercial |
$41.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$52.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.99
|
| Rate for Payer: Multiplan Commercial |
$52.46
|
| Rate for Payer: Networks By Design Commercial |
$45.47
|
| Rate for Payer: Prime Health Services Commercial |
$59.46
|
| Rate for Payer: Riverside University Health System MISP |
$27.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.98
|
| Rate for Payer: United Healthcare All Other HMO |
$34.98
|
| Rate for Payer: United Healthcare HMO Rider |
$34.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.46
|
| Rate for Payer: Vantage Medical Group Senior |
$59.46
|
|
|
HC DRSNG TEGADERM TRANSPARENT
|
Facility
|
OP
|
$1.72
|
|
| Hospital Charge Code |
901602654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.02
|
| Rate for Payer: Blue Distinction Transplant |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.10
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Media |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Riverside University Health System MISP |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
HC DRSNG TEGADERM TRANSPARENT
|
Facility
|
IP
|
$1.72
|
|
| Hospital Charge Code |
901602654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
|
|
HC DRSNG TELFA ISLAND 4 X 10
|
Facility
|
IP
|
$573.62
|
|
| Hospital Charge Code |
901602569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$516.26 |
| Rate for Payer: Cash Price |
$258.13
|
| Rate for Payer: Central Health Plan Commercial |
$458.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.45
|
| Rate for Payer: Galaxy Health WC |
$487.58
|
| Rate for Payer: Global Benefits Group Commercial |
$344.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.72
|
| Rate for Payer: Multiplan Commercial |
$430.22
|
| Rate for Payer: Networks By Design Commercial |
$372.85
|
| Rate for Payer: Prime Health Services Commercial |
$487.58
|
|
|
HC DRSNG TELFA ISLAND 4 X 10
|
Facility
|
OP
|
$573.62
|
|
| Hospital Charge Code |
901602569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$516.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$348.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$487.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$315.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$277.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$338.89
|
| Rate for Payer: Blue Distinction Transplant |
$344.17
|
| Rate for Payer: Blue Shield of California Commercial |
$360.81
|
| Rate for Payer: Blue Shield of California EPN |
$280.50
|
| Rate for Payer: Cash Price |
$258.13
|
| Rate for Payer: Central Health Plan Commercial |
$458.90
|
| Rate for Payer: Cigna of CA HMO |
$367.12
|
| Rate for Payer: Cigna of CA PPO |
$424.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.58
|
| Rate for Payer: Dignity Health Media |
$487.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$487.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.45
|
| Rate for Payer: Galaxy Health WC |
$487.58
|
| Rate for Payer: Global Benefits Group Commercial |
$344.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.26
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$430.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.72
|
| Rate for Payer: Multiplan Commercial |
$430.22
|
| Rate for Payer: Networks By Design Commercial |
$372.85
|
| Rate for Payer: Prime Health Services Commercial |
$487.58
|
| Rate for Payer: Riverside University Health System MISP |
$229.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$344.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.81
|
| Rate for Payer: United Healthcare All Other HMO |
$286.81
|
| Rate for Payer: United Healthcare HMO Rider |
$286.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$487.58
|
| Rate for Payer: Vantage Medical Group Senior |
$487.58
|
|
|
HC DRSNG TELFA ISLAND 4 X 14"
|
Facility
|
IP
|
$1,283.40
|
|
| Hospital Charge Code |
901602729
|
|
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 TELFA ISLAND 4 X 14"
|
Facility
|
OP
|
$1,283.40
|
|
| Hospital Charge Code |
901602729
|
|
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 THIN HYDROCOLLOID 4X4"
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
901698735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: 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 THIN HYDROCOLLOID 4X4"
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
901698735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: 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 TRACH DERMACEA 4X4
|
Facility
|
OP
|
$32.23
|
|
| Hospital Charge Code |
901601165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$29.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.04
|
| Rate for Payer: Blue Distinction Transplant |
$19.34
|
| Rate for Payer: Blue Shield of California Commercial |
$20.27
|
| Rate for Payer: Blue Shield of California EPN |
$15.76
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Central Health Plan Commercial |
$25.78
|
| Rate for Payer: Cigna of CA HMO |
$20.63
|
| Rate for Payer: Cigna of CA PPO |
$23.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.40
|
| Rate for Payer: Dignity Health Media |
$27.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.89
|
| Rate for Payer: Galaxy Health WC |
$27.40
|
| Rate for Payer: Global Benefits Group Commercial |
$19.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$24.17
|
| Rate for Payer: Networks By Design Commercial |
$20.95
|
| Rate for Payer: Prime Health Services Commercial |
$27.40
|
| Rate for Payer: Riverside University Health System MISP |
$12.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.12
|
| Rate for Payer: United Healthcare All Other HMO |
$16.12
|
| Rate for Payer: United Healthcare HMO Rider |
$16.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$27.40
|
|
|
HC DRSNG TRACH DERMACEA 4X4
|
Facility
|
IP
|
$32.23
|
|
| Hospital Charge Code |
901601165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$29.01 |
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Central Health Plan Commercial |
$25.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.89
|
| Rate for Payer: Galaxy Health WC |
$27.40
|
| Rate for Payer: Global Benefits Group Commercial |
$19.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$24.17
|
| Rate for Payer: Networks By Design Commercial |
$20.95
|
| Rate for Payer: Prime Health Services Commercial |
$27.40
|
|
|
HC DRSNG TRACHEOSTOMY 3.5X3.5
|
Facility
|
IP
|
$19.11
|
|
| Hospital Charge Code |
901698240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Central Health Plan Commercial |
$15.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$16.24
|
| Rate for Payer: Global Benefits Group Commercial |
$11.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$14.33
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Prime Health Services Commercial |
$16.24
|
|
|
HC DRSNG TRACHEOSTOMY 3.5X3.5
|
Facility
|
OP
|
$19.11
|
|
| Hospital Charge Code |
901698240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.29
|
| Rate for Payer: Blue Distinction Transplant |
$11.47
|
| Rate for Payer: Blue Shield of California Commercial |
$12.02
|
| Rate for Payer: Blue Shield of California EPN |
$9.34
|
| Rate for Payer: Cash Price |
$8.60
|
| Rate for Payer: Central Health Plan Commercial |
$15.29
|
| Rate for Payer: Cigna of CA HMO |
$12.23
|
| Rate for Payer: Cigna of CA PPO |
$14.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.24
|
| Rate for Payer: Dignity Health Media |
$16.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.64
|
| Rate for Payer: Galaxy Health WC |
$16.24
|
| Rate for Payer: Global Benefits Group Commercial |
$11.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$14.33
|
| Rate for Payer: Networks By Design Commercial |
$12.42
|
| Rate for Payer: Prime Health Services Commercial |
$16.24
|
| Rate for Payer: Riverside University Health System MISP |
$7.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.56
|
| Rate for Payer: United Healthcare All Other HMO |
$9.56
|
| Rate for Payer: United Healthcare HMO Rider |
$9.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.24
|
| Rate for Payer: Vantage Medical Group Senior |
$16.24
|
|
|
HC DRSNG TRANSPARENT 2 3/8X2 3/4
|
Facility
|
OP
|
$1.31
|
|
| Hospital Charge Code |
901605326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: Blue Distinction Transplant |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.11
|
| Rate for Payer: Dignity Health Media |
$1.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
| Rate for Payer: Riverside University Health System MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
HC DRSNG TRANSPARENT 2 3/8X2 3/4
|
Facility
|
IP
|
$1.31
|
|
| Hospital Charge Code |
901605326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
|
|
HC DRSNG TRANSPARENT 2.75X3.2
|
Facility
|
OP
|
$5.41
|
|
| Hospital Charge Code |
901604070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.20
|
| Rate for Payer: Blue Distinction Transplant |
$3.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$4.33
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$4.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.60
|
| Rate for Payer: Dignity Health Media |
$4.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.60
|
| Rate for Payer: Riverside University Health System MISP |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4.60
|
|
