|
HC DRSNG TRANSPARENT 2.75X3.2
|
Facility
|
IP
|
$5.41
|
|
| Hospital Charge Code |
901604070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
|
HC DRSNG TRANSPARENT 2"X1.75"
|
Facility
|
IP
|
$17.14
|
|
| Hospital Charge Code |
901605418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$15.43 |
| Rate for Payer: Cash Price |
$7.71
|
| Rate for Payer: Central Health Plan Commercial |
$13.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.86
|
| Rate for Payer: Galaxy Health WC |
$14.57
|
| Rate for Payer: Global Benefits Group Commercial |
$10.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Networks By Design Commercial |
$11.14
|
| Rate for Payer: Prime Health Services Commercial |
$14.57
|
|
|
HC DRSNG TRANSPARENT 2"X1.75"
|
Facility
|
OP
|
$17.14
|
|
| Hospital Charge Code |
901605418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$15.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.13
|
| Rate for Payer: Blue Distinction Transplant |
$10.28
|
| Rate for Payer: Blue Shield of California Commercial |
$10.78
|
| Rate for Payer: Blue Shield of California EPN |
$8.38
|
| Rate for Payer: Cash Price |
$7.71
|
| Rate for Payer: Central Health Plan Commercial |
$13.71
|
| Rate for Payer: Cigna of CA HMO |
$10.97
|
| Rate for Payer: Cigna of CA PPO |
$12.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.57
|
| Rate for Payer: Dignity Health Media |
$14.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.86
|
| Rate for Payer: Galaxy Health WC |
$14.57
|
| Rate for Payer: Global Benefits Group Commercial |
$10.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Networks By Design Commercial |
$11.14
|
| Rate for Payer: Prime Health Services Commercial |
$14.57
|
| Rate for Payer: Riverside University Health System MISP |
$6.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.57
|
| Rate for Payer: United Healthcare All Other HMO |
$8.57
|
| Rate for Payer: United Healthcare HMO Rider |
$8.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$14.57
|
|
|
HC DRSNG TRANSPARENT 2X2.25"
|
Facility
|
OP
|
$7.79
|
|
| Hospital Charge Code |
901698711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.60
|
| Rate for Payer: Blue Distinction Transplant |
$4.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4.90
|
| Rate for Payer: Blue Shield of California EPN |
$3.81
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Central Health Plan Commercial |
$6.23
|
| Rate for Payer: Cigna of CA HMO |
$4.99
|
| Rate for Payer: Cigna of CA PPO |
$5.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.62
|
| Rate for Payer: Dignity Health Media |
$6.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
| Rate for Payer: Riverside University Health System MISP |
$3.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.62
|
| Rate for Payer: Vantage Medical Group Senior |
$6.62
|
|
|
HC DRSNG TRANSPARENT 2X2.25"
|
Facility
|
IP
|
$7.79
|
|
| Hospital Charge Code |
901698711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Central Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
|
|
HC DRSNG TRANSPARENT 2X2.5" STRL
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698602
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.05
|
| 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 TRANSPARENT 2X2.5" STRL
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698602
|
|
Hospital Revenue Code
|
270
|
| 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 TRANSPARENT 4 X 4 3/4
|
Facility
|
OP
|
$3.85
|
|
| Hospital Charge Code |
901605327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.34
|
| 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: 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 TRANSPARENT 4 X 4 3/4
|
Facility
|
IP
|
$3.85
|
|
| Hospital Charge Code |
901605327
|
|
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 TRANSPARENT FILM
|
Facility
|
IP
|
$76.10
|
|
| Hospital Charge Code |
901698188
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Central Health Plan Commercial |
$60.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.68
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.22
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: Networks By Design Commercial |
$49.46
|
| Rate for Payer: Prime Health Services Commercial |
$64.68
|
|
|
HC DRSNG TRANSPARENT FILM
|
Facility
|
OP
|
$76.10
|
|
| Hospital Charge Code |
901698188
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.96
|
| Rate for Payer: Blue Distinction Transplant |
$45.66
|
| Rate for Payer: Blue Shield of California Commercial |
$47.87
|
| Rate for Payer: Blue Shield of California EPN |
$37.21
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Central Health Plan Commercial |
$60.88
|
| Rate for Payer: Cigna of CA HMO |
$48.70
|
| Rate for Payer: Cigna of CA PPO |
$56.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.68
|
| Rate for Payer: Dignity Health Media |
$64.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.68
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$57.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.22
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: Networks By Design Commercial |
$49.46
|
| Rate for Payer: Prime Health Services Commercial |
$64.68
|
| Rate for Payer: Riverside University Health System MISP |
$30.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.68
|
| Rate for Payer: Vantage Medical Group Senior |
$64.68
|
|
|
HC DRSNG TRANSPARENT FILM 4X4IN
|
Facility
|
OP
|
$316.82
|
|
| Hospital Charge Code |
901698577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$285.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$192.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$269.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$174.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$153.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.18
|
| Rate for Payer: Blue Distinction Transplant |
$190.09
|
| Rate for Payer: Blue Shield of California Commercial |
$199.28
|
| Rate for Payer: Blue Shield of California EPN |
$154.92
|
| Rate for Payer: Cash Price |
$142.57
|
| Rate for Payer: Central Health Plan Commercial |
$253.46
|
| Rate for Payer: Cigna of CA HMO |
$202.76
|
| Rate for Payer: Cigna of CA PPO |
$234.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$269.30
|
| Rate for Payer: Dignity Health Media |
$269.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$269.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.73
|
| Rate for Payer: Galaxy Health WC |
$269.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$285.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$237.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$211.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Multiplan Commercial |
$237.62
|
| Rate for Payer: Networks By Design Commercial |
$205.93
|
| Rate for Payer: Prime Health Services Commercial |
$269.30
|
| Rate for Payer: Riverside University Health System MISP |
$126.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.41
|
| Rate for Payer: United Healthcare All Other HMO |
$158.41
|
| Rate for Payer: United Healthcare HMO Rider |
$158.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$269.30
|
| Rate for Payer: Vantage Medical Group Senior |
$269.30
|
|
|
HC DRSNG TRANSPARENT FILM 4X4IN
|
Facility
|
IP
|
$316.82
|
|
| Hospital Charge Code |
901698577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$285.14 |
| Rate for Payer: Cash Price |
$142.57
|
| Rate for Payer: Central Health Plan Commercial |
$253.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.73
|
| Rate for Payer: Galaxy Health WC |
$269.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$285.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$211.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Multiplan Commercial |
$237.62
|
| Rate for Payer: Networks By Design Commercial |
$205.93
|
| Rate for Payer: Prime Health Services Commercial |
$269.30
|
|
|
HC DRSNG TRANSPARENT IV3000 4"X5"
|
Facility
|
OP
|
$7.95
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901607678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.70
|
| Rate for Payer: Blue Distinction Transplant |
$4.77
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$3.89
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Media |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Riverside University Health System MISP |
$3.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC DRSNG TRANSPARENT IV3000 4"X5"
|
Facility
|
IP
|
$7.95
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901607678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
|
HC DRSNG TRANSPARENT IV3000 4X8IN
|
Facility
|
OP
|
$14.19
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901607688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.38
|
| Rate for Payer: Blue Distinction Transplant |
$8.51
|
| Rate for Payer: Blue Shield of California Commercial |
$8.93
|
| Rate for Payer: Blue Shield of California EPN |
$6.94
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Central Health Plan Commercial |
$11.35
|
| Rate for Payer: Cigna of CA HMO |
$9.08
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.06
|
| Rate for Payer: Dignity Health Media |
$12.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
| Rate for Payer: Riverside University Health System MISP |
$5.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.10
|
| Rate for Payer: United Healthcare All Other HMO |
$7.10
|
| Rate for Payer: United Healthcare HMO Rider |
$7.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.06
|
| Rate for Payer: Vantage Medical Group Senior |
$12.06
|
|
|
HC DRSNG TRANSPARENT IV3000 4X8IN
|
Facility
|
IP
|
$14.19
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901607688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Central Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.84
|
| Rate for Payer: Multiplan Commercial |
$10.64
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
|
|
HC DRSNG TRANSPRNT HYDRO 4X4 PLUS
|
Facility
|
OP
|
$10.82
|
|
| Hospital Charge Code |
901698752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.39
|
| Rate for Payer: Blue Distinction Transplant |
$6.49
|
| Rate for Payer: Blue Shield of California Commercial |
$6.81
|
| Rate for Payer: Blue Shield of California EPN |
$5.29
|
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: Central Health Plan Commercial |
$8.66
|
| Rate for Payer: Cigna of CA HMO |
$6.92
|
| Rate for Payer: Cigna of CA PPO |
$8.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.20
|
| Rate for Payer: Dignity Health Media |
$9.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.33
|
| Rate for Payer: Galaxy Health WC |
$9.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$8.12
|
| Rate for Payer: Networks By Design Commercial |
$7.03
|
| Rate for Payer: Prime Health Services Commercial |
$9.20
|
| Rate for Payer: Riverside University Health System MISP |
$4.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.41
|
| Rate for Payer: United Healthcare HMO Rider |
$5.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.20
|
| Rate for Payer: Vantage Medical Group Senior |
$9.20
|
|
|
HC DRSNG TRANSPRNT HYDRO 4X4 PLUS
|
Facility
|
IP
|
$10.82
|
|
| Hospital Charge Code |
901698752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: Central Health Plan Commercial |
$8.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: Galaxy Health WC |
$9.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$8.12
|
| Rate for Payer: Networks By Design Commercial |
$7.03
|
| Rate for Payer: Prime Health Services Commercial |
$9.20
|
|
|
HC DRSNG TRANSPRNT HYDRO 4X4 THIN
|
Facility
|
OP
|
$8.36
|
|
| Hospital Charge Code |
901698751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.94
|
| Rate for Payer: Blue Distinction Transplant |
$5.02
|
| Rate for Payer: Blue Shield of California Commercial |
$5.26
|
| Rate for Payer: Blue Shield of California EPN |
$4.09
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: Cigna of CA HMO |
$5.35
|
| Rate for Payer: Cigna of CA PPO |
$6.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.11
|
| Rate for Payer: Dignity Health Media |
$7.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
| Rate for Payer: Riverside University Health System MISP |
$3.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Other HMO |
$4.18
|
| Rate for Payer: United Healthcare HMO Rider |
$4.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.11
|
| Rate for Payer: Vantage Medical Group Senior |
$7.11
|
|
|
HC DRSNG TRANSPRNT HYDRO 4X4 THIN
|
Facility
|
IP
|
$8.36
|
|
| Hospital Charge Code |
901698751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$7.52 |
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Central Health Plan Commercial |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.34
|
| Rate for Payer: Galaxy Health WC |
$7.11
|
| Rate for Payer: Global Benefits Group Commercial |
$5.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$6.27
|
| Rate for Payer: Networks By Design Commercial |
$5.43
|
| Rate for Payer: Prime Health Services Commercial |
$7.11
|
|
|
HC DRSNG TRNSPRNT 2.75X3.2 HRMT
|
Facility
|
IP
|
$3.60
|
|
| Hospital Charge Code |
901692016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
HC DRSNG TRNSPRNT 2.75X3.2 HRMT
|
Facility
|
OP
|
$3.60
|
|
| Hospital Charge Code |
901692016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.13
|
| Rate for Payer: Blue Distinction Transplant |
$2.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California EPN |
$1.76
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Media |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
HC DRSNG VAC ACTICOAT FLEX 3 4X4
|
Facility
|
OP
|
$102.60
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.62
|
| Rate for Payer: Blue Distinction Transplant |
$61.56
|
| Rate for Payer: Blue Shield of California Commercial |
$64.54
|
| Rate for Payer: Blue Shield of California EPN |
$50.17
|
| Rate for Payer: Cash Price |
$46.17
|
| Rate for Payer: Cash Price |
$46.17
|
| Rate for Payer: Central Health Plan Commercial |
$82.08
|
| Rate for Payer: Cigna of CA HMO |
$65.66
|
| Rate for Payer: Cigna of CA PPO |
$75.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.21
|
| Rate for Payer: Dignity Health Media |
$87.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.04
|
| Rate for Payer: Galaxy Health WC |
$87.21
|
| Rate for Payer: Global Benefits Group Commercial |
$61.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$76.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.52
|
| Rate for Payer: Multiplan Commercial |
$76.95
|
| Rate for Payer: Networks By Design Commercial |
$66.69
|
| Rate for Payer: Prime Health Services Commercial |
$87.21
|
| Rate for Payer: Riverside University Health System MISP |
$41.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.30
|
| Rate for Payer: United Healthcare All Other HMO |
$51.30
|
| Rate for Payer: United Healthcare HMO Rider |
$51.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.21
|
| Rate for Payer: Vantage Medical Group Senior |
$87.21
|
|
|
HC DRSNG VAC ACTICOAT FLEX 3 4X4
|
Facility
|
IP
|
$102.60
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Cash Price |
$46.17
|
| Rate for Payer: Central Health Plan Commercial |
$82.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.04
|
| Rate for Payer: Galaxy Health WC |
$87.21
|
| Rate for Payer: Global Benefits Group Commercial |
$61.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.52
|
| Rate for Payer: Multiplan Commercial |
$76.95
|
| Rate for Payer: Networks By Design Commercial |
$66.69
|
| Rate for Payer: Prime Health Services Commercial |
$87.21
|
|
