|
HC DRSNG ABSORBNT COMPOSITE 4X10
|
Facility
|
OP
|
$13.12
|
|
| Hospital Charge Code |
901698912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.06
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.18
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.15
|
| Rate for Payer: Vantage Medical Group Senior |
$11.15
|
|
|
HC DRSNG ABSORBNT COMPOSITE 4X10
|
Facility
|
IP
|
$13.12
|
|
| Hospital Charge Code |
901698912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
|
|
HC DRSNG ACTICOAT 4X10 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$210.77
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$179.15 |
| Rate for Payer: Adventist Health Commercial |
$42.15
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.31
|
| Rate for Payer: EPIC Health Plan Senior |
$84.31
|
| Rate for Payer: Galaxy Health WC |
$179.15
|
| Rate for Payer: Global Benefits Group Commercial |
$126.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.58
|
| Rate for Payer: Multiplan Commercial |
$168.62
|
| Rate for Payer: Networks By Design Commercial |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$179.15
|
|
|
HC DRSNG ACTICOAT 4X10 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$210.77
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$179.15 |
| Rate for Payer: Adventist Health Commercial |
$42.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.43
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cigna of CA HMO |
$134.89
|
| Rate for Payer: Cigna of CA PPO |
$155.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$179.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$179.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.31
|
| Rate for Payer: EPIC Health Plan Senior |
$84.31
|
| Rate for Payer: Galaxy Health WC |
$179.15
|
| Rate for Payer: Global Benefits Group Commercial |
$126.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.54
|
| Rate for Payer: Multiplan Commercial |
$168.62
|
| Rate for Payer: Networks By Design Commercial |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$179.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.39
|
| Rate for Payer: United Healthcare All Other HMO |
$105.39
|
| Rate for Payer: United Healthcare HMO Rider |
$105.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$179.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$179.15
|
| Rate for Payer: Vantage Medical Group Senior |
$179.15
|
|
|
HC DRSNG ACTICOAT 4X13 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$953.07
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901606857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.61 |
| Max. Negotiated Rate |
$810.11 |
| Rate for Payer: Adventist Health Commercial |
$190.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$625.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$810.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$524.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$714.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.28
|
| Rate for Payer: Cash Price |
$524.19
|
| Rate for Payer: Cigna of CA HMO |
$609.96
|
| Rate for Payer: Cigna of CA PPO |
$705.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$810.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$810.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$810.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.23
|
| Rate for Payer: EPIC Health Plan Senior |
$381.23
|
| Rate for Payer: Galaxy Health WC |
$810.11
|
| Rate for Payer: Global Benefits Group Commercial |
$571.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$635.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$589.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.15
|
| Rate for Payer: Multiplan Commercial |
$762.46
|
| Rate for Payer: Networks By Design Commercial |
$619.50
|
| Rate for Payer: Prime Health Services Commercial |
$810.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$571.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$571.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$476.54
|
| Rate for Payer: United Healthcare All Other HMO |
$476.54
|
| Rate for Payer: United Healthcare HMO Rider |
$476.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$810.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$810.11
|
| Rate for Payer: Vantage Medical Group Senior |
$810.11
|
|
|
HC DRSNG ACTICOAT 4X13 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$953.07
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901606857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.61 |
| Max. Negotiated Rate |
$810.11 |
| Rate for Payer: Adventist Health Commercial |
$190.61
|
| Rate for Payer: Cash Price |
$524.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.23
|
| Rate for Payer: EPIC Health Plan Senior |
$381.23
|
| Rate for Payer: Galaxy Health WC |
$810.11
|
| Rate for Payer: Global Benefits Group Commercial |
$571.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$635.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$589.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.74
|
| Rate for Payer: Multiplan Commercial |
$762.46
|
| Rate for Payer: Networks By Design Commercial |
$619.50
|
| Rate for Payer: Prime Health Services Commercial |
$810.11
|
|
|
HC DRSNG ACTICOAT 4X4 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$134.22
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$114.09 |
| Rate for Payer: Adventist Health Commercial |
$26.84
|
| Rate for Payer: Cash Price |
$73.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.69
|
| Rate for Payer: EPIC Health Plan Senior |
$53.69
|
| Rate for Payer: Galaxy Health WC |
$114.09
|
| Rate for Payer: Global Benefits Group Commercial |
$80.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.21
|
| Rate for Payer: Multiplan Commercial |
$107.38
|
| Rate for Payer: Networks By Design Commercial |
$87.24
|
| Rate for Payer: Prime Health Services Commercial |
$114.09
|
|
|
HC DRSNG ACTICOAT 4X4 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$134.22
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$114.09 |
| Rate for Payer: Adventist Health Commercial |
$26.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.42
|
| Rate for Payer: Cash Price |
$73.82
|
| Rate for Payer: Cigna of CA HMO |
$85.90
|
| Rate for Payer: Cigna of CA PPO |
$99.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.69
|
| Rate for Payer: EPIC Health Plan Senior |
$53.69
|
| Rate for Payer: Galaxy Health WC |
$114.09
|
| Rate for Payer: Global Benefits Group Commercial |
$80.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.95
|
| Rate for Payer: Multiplan Commercial |
$107.38
|
| Rate for Payer: Networks By Design Commercial |
$87.24
|
| Rate for Payer: Prime Health Services Commercial |
$114.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.11
|
| Rate for Payer: United Healthcare All Other HMO |
$67.11
|
| Rate for Payer: United Healthcare HMO Rider |
$67.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.09
|
| Rate for Payer: Vantage Medical Group Senior |
$114.09
|
|
|
HC DRSNG ACTICOAT 4X8 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$195.44
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.09 |
| Max. Negotiated Rate |
$166.12 |
| Rate for Payer: Adventist Health Commercial |
$39.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.02
|
| Rate for Payer: Cash Price |
$107.49
|
| Rate for Payer: Cigna of CA HMO |
$125.08
|
| Rate for Payer: Cigna of CA PPO |
$144.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.18
|
| Rate for Payer: EPIC Health Plan Senior |
$78.18
|
| Rate for Payer: Galaxy Health WC |
$166.12
|
| Rate for Payer: Global Benefits Group Commercial |
$117.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.81
|
| Rate for Payer: Multiplan Commercial |
$156.35
|
| Rate for Payer: Networks By Design Commercial |
$127.04
|
| Rate for Payer: Prime Health Services Commercial |
$166.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.72
|
| Rate for Payer: United Healthcare All Other HMO |
$97.72
|
| Rate for Payer: United Healthcare HMO Rider |
$97.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.12
|
| Rate for Payer: Vantage Medical Group Senior |
$166.12
|
|
|
HC DRSNG ACTICOAT 4X8 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$195.44
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.09 |
| Max. Negotiated Rate |
$166.12 |
| Rate for Payer: Adventist Health Commercial |
$39.09
|
| Rate for Payer: Cash Price |
$107.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.18
|
| Rate for Payer: EPIC Health Plan Senior |
$78.18
|
| Rate for Payer: Galaxy Health WC |
$166.12
|
| Rate for Payer: Global Benefits Group Commercial |
$117.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.91
|
| Rate for Payer: Multiplan Commercial |
$156.35
|
| Rate for Payer: Networks By Design Commercial |
$127.04
|
| Rate for Payer: Prime Health Services Commercial |
$166.12
|
|
|
HC DRSNG ACTICOAT 4X8" FLX 3
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.34
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC DRSNG ACTICOAT 4X8" FLX 3
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC DRSNG ACTICOAT 8"X16" 231304
|
Facility
|
OP
|
$318.50
|
|
|
Service Code
|
CPT A6253
|
| Hospital Charge Code |
901698100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$270.73 |
| Rate for Payer: Adventist Health Commercial |
$63.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.59
|
| Rate for Payer: Cash Price |
$175.18
|
| Rate for Payer: Cigna of CA HMO |
$203.84
|
| Rate for Payer: Cigna of CA PPO |
$235.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$270.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.40
|
| Rate for Payer: EPIC Health Plan Senior |
$127.40
|
| Rate for Payer: Galaxy Health WC |
$270.73
|
| Rate for Payer: Global Benefits Group Commercial |
$191.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$222.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$222.95
|
| Rate for Payer: Multiplan Commercial |
$254.80
|
| Rate for Payer: Networks By Design Commercial |
$207.03
|
| Rate for Payer: Prime Health Services Commercial |
$270.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$191.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$191.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$159.25
|
| Rate for Payer: United Healthcare All Other HMO |
$159.25
|
| Rate for Payer: United Healthcare HMO Rider |
$159.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.73
|
| Rate for Payer: Vantage Medical Group Senior |
$270.73
|
|
|
HC DRSNG ACTICOAT 8"X16" 231304
|
Facility
|
IP
|
$318.50
|
|
|
Service Code
|
CPT A6253
|
| Hospital Charge Code |
901698100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$270.73 |
| Rate for Payer: Adventist Health Commercial |
$63.70
|
| Rate for Payer: Cash Price |
$175.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.40
|
| Rate for Payer: EPIC Health Plan Senior |
$127.40
|
| Rate for Payer: Galaxy Health WC |
$270.73
|
| Rate for Payer: Global Benefits Group Commercial |
$191.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$197.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.44
|
| Rate for Payer: Multiplan Commercial |
$254.80
|
| Rate for Payer: Networks By Design Commercial |
$207.03
|
| Rate for Payer: Prime Health Services Commercial |
$270.73
|
|
|
HC DRSNG ADAPTIC 8X3IN NON ADHRNT
|
Facility
|
IP
|
$7.38
|
|
| Hospital Charge Code |
901698164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
|
|
HC DRSNG ADAPTIC 8X3IN NON ADHRNT
|
Facility
|
OP
|
$7.38
|
|
| Hospital Charge Code |
901698164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.53
|
| Rate for Payer: Cash Price |
$4.06
|
| Rate for Payer: Cigna of CA HMO |
$4.72
|
| Rate for Payer: Cigna of CA PPO |
$5.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Senior |
$2.95
|
| Rate for Payer: Galaxy Health WC |
$6.27
|
| Rate for Payer: Global Benefits Group Commercial |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$4.80
|
| Rate for Payer: Prime Health Services Commercial |
$6.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.69
|
| Rate for Payer: United Healthcare All Other HMO |
$3.69
|
| Rate for Payer: United Healthcare HMO Rider |
$3.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.27
|
|
|
HC DRSNG ALLEVYN 2 3/8" X 4 3/4"
|
Facility
|
IP
|
$11.64
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901607772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$9.89 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Senior |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$9.31
|
| Rate for Payer: Networks By Design Commercial |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$9.89
|
|
|
HC DRSNG ALLEVYN 2 3/8" X 4 3/4"
|
Facility
|
OP
|
$11.64
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901607772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$9.89 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.15
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cigna of CA HMO |
$7.45
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Senior |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$9.31
|
| Rate for Payer: Networks By Design Commercial |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$9.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO |
$5.82
|
| Rate for Payer: United Healthcare HMO Rider |
$5.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.89
|
| Rate for Payer: Vantage Medical Group Senior |
$9.89
|
|
|
HC DRSNG ALLEVYN GB LITE 2" X 2"
|
Facility
|
OP
|
$11.07
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901608075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.80
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Cigna of CA HMO |
$7.08
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: Galaxy Health WC |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$9.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.54
|
| Rate for Payer: United Healthcare All Other HMO |
$5.54
|
| Rate for Payer: United Healthcare HMO Rider |
$5.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.41
|
| Rate for Payer: Vantage Medical Group Senior |
$9.41
|
|
|
HC DRSNG ALLEVYN GB LITE 2" X 2"
|
Facility
|
IP
|
$11.07
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901608075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: Galaxy Health WC |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.66
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$9.41
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 12"
|
Facility
|
IP
|
$50.51
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$42.93 |
| Rate for Payer: Adventist Health Commercial |
$10.10
|
| Rate for Payer: Cash Price |
$27.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.20
|
| Rate for Payer: EPIC Health Plan Senior |
$20.20
|
| Rate for Payer: Galaxy Health WC |
$42.93
|
| Rate for Payer: Global Benefits Group Commercial |
$30.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.12
|
| Rate for Payer: Multiplan Commercial |
$40.41
|
| Rate for Payer: Networks By Design Commercial |
$32.83
|
| Rate for Payer: Prime Health Services Commercial |
$42.93
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 12"
|
Facility
|
OP
|
$50.51
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$42.93 |
| Rate for Payer: Adventist Health Commercial |
$10.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.02
|
| Rate for Payer: Cash Price |
$27.78
|
| Rate for Payer: Cigna of CA HMO |
$32.33
|
| Rate for Payer: Cigna of CA PPO |
$37.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.20
|
| Rate for Payer: EPIC Health Plan Senior |
$20.20
|
| Rate for Payer: Galaxy Health WC |
$42.93
|
| Rate for Payer: Global Benefits Group Commercial |
$30.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.36
|
| Rate for Payer: Multiplan Commercial |
$40.41
|
| Rate for Payer: Networks By Design Commercial |
$32.83
|
| Rate for Payer: Prime Health Services Commercial |
$42.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.25
|
| Rate for Payer: United Healthcare All Other HMO |
$25.25
|
| Rate for Payer: United Healthcare HMO Rider |
$25.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.93
|
| Rate for Payer: Vantage Medical Group Senior |
$42.93
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 8"
|
Facility
|
OP
|
$30.50
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$25.93 |
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Adventist Health Commercial |
$6.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.73
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cigna of CA HMO |
$19.52
|
| Rate for Payer: Cigna of CA PPO |
$22.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.20
|
| Rate for Payer: Galaxy Health WC |
$25.93
|
| Rate for Payer: Global Benefits Group Commercial |
$18.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.35
|
| Rate for Payer: Multiplan Commercial |
$24.40
|
| Rate for Payer: Networks By Design Commercial |
$19.82
|
| Rate for Payer: Prime Health Services Commercial |
$25.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.25
|
| Rate for Payer: United Healthcare HMO Rider |
$15.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$25.93
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 8"
|
Facility
|
IP
|
$30.50
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$25.93 |
| Rate for Payer: Adventist Health Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.20
|
| Rate for Payer: Galaxy Health WC |
$25.93
|
| Rate for Payer: Global Benefits Group Commercial |
$18.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.32
|
| Rate for Payer: Multiplan Commercial |
$24.40
|
| Rate for Payer: Networks By Design Commercial |
$19.82
|
| Rate for Payer: Prime Health Services Commercial |
$25.93
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 9"
|
Facility
|
OP
|
$38.13
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$32.41 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.42
|
| Rate for Payer: Cash Price |
$20.97
|
| Rate for Payer: Cigna of CA HMO |
$24.40
|
| Rate for Payer: Cigna of CA PPO |
$28.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.69
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.07
|
| Rate for Payer: United Healthcare All Other HMO |
$19.07
|
| Rate for Payer: United Healthcare HMO Rider |
$19.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.41
|
| Rate for Payer: Vantage Medical Group Senior |
$32.41
|
|
