|
HC DRSNG POLYMEM 4.5X4.5" NON-ADH
|
Facility
|
IP
|
$41.08
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Adventist Health Commercial |
$8.22
|
| Rate for Payer: Cash Price |
$22.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.43
|
| Rate for Payer: EPIC Health Plan Senior |
$16.43
|
| Rate for Payer: Galaxy Health WC |
$34.92
|
| Rate for Payer: Global Benefits Group Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.86
|
| Rate for Payer: Multiplan Commercial |
$32.86
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$34.92
|
|
|
HC DRSNG POLYMEM 4.5X4.5" NON-ADH
|
Facility
|
OP
|
$41.08
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Adventist Health Commercial |
$8.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.23
|
| Rate for Payer: Cash Price |
$22.59
|
| Rate for Payer: Cigna of CA HMO |
$26.29
|
| Rate for Payer: Cigna of CA PPO |
$30.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.43
|
| Rate for Payer: EPIC Health Plan Senior |
$16.43
|
| Rate for Payer: Galaxy Health WC |
$34.92
|
| Rate for Payer: Global Benefits Group Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.76
|
| Rate for Payer: Multiplan Commercial |
$32.86
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$34.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.54
|
| Rate for Payer: United Healthcare All Other HMO |
$20.54
|
| Rate for Payer: United Healthcare HMO Rider |
$20.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.92
|
| Rate for Payer: Vantage Medical Group Senior |
$34.92
|
|
|
HC DRSNG,POLYMEM 4X4" NON-ADH FOA
|
Facility
|
OP
|
$25.99
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$22.09 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.96
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Cigna of CA HMO |
$16.63
|
| Rate for Payer: Cigna of CA PPO |
$19.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.09
|
| Rate for Payer: Global Benefits Group Commercial |
$15.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.19
|
| Rate for Payer: Multiplan Commercial |
$20.79
|
| Rate for Payer: Networks By Design Commercial |
$16.89
|
| Rate for Payer: Prime Health Services Commercial |
$22.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.99
|
| Rate for Payer: United Healthcare All Other HMO |
$12.99
|
| Rate for Payer: United Healthcare HMO Rider |
$12.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.09
|
| Rate for Payer: Vantage Medical Group Senior |
$22.09
|
|
|
HC DRSNG,POLYMEM 4X4" NON-ADH FOA
|
Facility
|
IP
|
$25.99
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$22.09 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.09
|
| Rate for Payer: Global Benefits Group Commercial |
$15.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$20.79
|
| Rate for Payer: Networks By Design Commercial |
$16.89
|
| Rate for Payer: Prime Health Services Commercial |
$22.09
|
|
|
HC DRSNG,POLYMEM 6X6" NON-ADH FOA
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRSNG,POLYMEM 6X6" NON-ADH FOA
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC DRSNG POLYMEM MAX 8X8" NON-ADH
|
Facility
|
OP
|
$106.55
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$90.57 |
| Rate for Payer: Adventist Health Commercial |
$21.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.43
|
| Rate for Payer: Cash Price |
$58.60
|
| Rate for Payer: Cigna of CA HMO |
$68.19
|
| Rate for Payer: Cigna of CA PPO |
$78.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.62
|
| Rate for Payer: EPIC Health Plan Senior |
$42.62
|
| Rate for Payer: Galaxy Health WC |
$90.57
|
| Rate for Payer: Global Benefits Group Commercial |
$63.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.58
|
| Rate for Payer: Multiplan Commercial |
$85.24
|
| Rate for Payer: Networks By Design Commercial |
$69.26
|
| Rate for Payer: Prime Health Services Commercial |
$90.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.27
|
| Rate for Payer: United Healthcare All Other HMO |
$53.27
|
| Rate for Payer: United Healthcare HMO Rider |
$53.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.57
|
| Rate for Payer: Vantage Medical Group Senior |
$90.57
|
|
|
HC DRSNG POLYMEM MAX 8X8" NON-ADH
|
Facility
|
IP
|
$106.55
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$90.57 |
| Rate for Payer: Adventist Health Commercial |
$21.31
|
| Rate for Payer: Cash Price |
$58.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.62
|
| Rate for Payer: EPIC Health Plan Senior |
$42.62
|
| Rate for Payer: Galaxy Health WC |
$90.57
|
| Rate for Payer: Global Benefits Group Commercial |
$63.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.57
|
| Rate for Payer: Multiplan Commercial |
$85.24
|
| Rate for Payer: Networks By Design Commercial |
$69.26
|
| Rate for Payer: Prime Health Services Commercial |
$90.57
|
|
|
HC DRSNG POLYM OVAL #3, 2X1" SLCN
|
Facility
|
IP
|
$11.32
|
|
| Hospital Charge Code |
901698349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Cash Price |
$6.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.53
|
| Rate for Payer: EPIC Health Plan Senior |
$4.53
|
| Rate for Payer: Galaxy Health WC |
$9.62
|
| Rate for Payer: Global Benefits Group Commercial |
$6.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.06
|
| Rate for Payer: Networks By Design Commercial |
$7.36
|
| Rate for Payer: Prime Health Services Commercial |
$9.62
|
|
|
HC DRSNG POLYM OVAL #3, 2X1" SLCN
|
Facility
|
OP
|
$11.32
|
|
| Hospital Charge Code |
901698349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.95
|
| Rate for Payer: Cash Price |
$6.23
|
| Rate for Payer: Cigna of CA HMO |
$7.24
|
| Rate for Payer: Cigna of CA PPO |
$8.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.53
|
| Rate for Payer: EPIC Health Plan Senior |
$4.53
|
| Rate for Payer: Galaxy Health WC |
$9.62
|
| Rate for Payer: Global Benefits Group Commercial |
$6.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$9.06
|
| Rate for Payer: Networks By Design Commercial |
$7.36
|
| Rate for Payer: Prime Health Services Commercial |
$9.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.66
|
| Rate for Payer: United Healthcare All Other HMO |
$5.66
|
| Rate for Payer: United Healthcare HMO Rider |
$5.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.62
|
| Rate for Payer: Vantage Medical Group Senior |
$9.62
|
|
|
HC DRSNG POLYM OVAL #5, 3X2" SLCN
|
Facility
|
OP
|
$24.11
|
|
| Hospital Charge Code |
901698350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$20.49 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.81
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cigna of CA HMO |
$15.43
|
| Rate for Payer: Cigna of CA PPO |
$17.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.64
|
| Rate for Payer: EPIC Health Plan Senior |
$9.64
|
| Rate for Payer: Galaxy Health WC |
$20.49
|
| Rate for Payer: Global Benefits Group Commercial |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.88
|
| Rate for Payer: Multiplan Commercial |
$19.29
|
| Rate for Payer: Networks By Design Commercial |
$15.67
|
| Rate for Payer: Prime Health Services Commercial |
$20.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO |
$12.05
|
| Rate for Payer: United Healthcare HMO Rider |
$12.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.49
|
| Rate for Payer: Vantage Medical Group Senior |
$20.49
|
|
|
HC DRSNG POLYM OVAL #5, 3X2" SLCN
|
Facility
|
IP
|
$24.11
|
|
| Hospital Charge Code |
901698350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$20.49 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.64
|
| Rate for Payer: EPIC Health Plan Senior |
$9.64
|
| Rate for Payer: Galaxy Health WC |
$20.49
|
| Rate for Payer: Global Benefits Group Commercial |
$14.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.79
|
| Rate for Payer: Multiplan Commercial |
$19.29
|
| Rate for Payer: Networks By Design Commercial |
$15.67
|
| Rate for Payer: Prime Health Services Commercial |
$20.49
|
|
|
HC DRSNG PRIMAPORE 6X3 1/8" ADHSV
|
Facility
|
OP
|
$4.02
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901698885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.47
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna of CA HMO |
$2.57
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$3.22
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2.01
|
| Rate for Payer: United Healthcare HMO Rider |
$2.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: Vantage Medical Group Senior |
$3.42
|
|
|
HC DRSNG PRIMAPORE 6X3 1/8" ADHSV
|
Facility
|
IP
|
$4.02
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901698885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$3.22
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.42
|
|
|
HC DRSNG PRIMAPORE 8 X 4"
|
Facility
|
IP
|
$6.72
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901604508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$5.38
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Prime Health Services Commercial |
$5.71
|
|
|
HC DRSNG PRIMAPORE 8 X 4"
|
Facility
|
OP
|
$6.72
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901604508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.13
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cigna of CA HMO |
$4.30
|
| Rate for Payer: Cigna of CA PPO |
$4.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$5.38
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Prime Health Services Commercial |
$5.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.71
|
| Rate for Payer: Vantage Medical Group Senior |
$5.71
|
|
|
HC DRSNG QUICKCLOT HEMO 4X4"
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
901698425
|
|
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 QUICKCLOT HEMO 4X4"
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
901698425
|
|
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 QUICKCLOT Z-FOLD
|
Facility
|
IP
|
$304.92
|
|
| Hospital Charge Code |
901608008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$259.18 |
| Rate for Payer: Adventist Health Commercial |
$60.98
|
| Rate for Payer: Cash Price |
$167.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.97
|
| Rate for Payer: EPIC Health Plan Senior |
$121.97
|
| Rate for Payer: Galaxy Health WC |
$259.18
|
| Rate for Payer: Global Benefits Group Commercial |
$182.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.18
|
| Rate for Payer: Multiplan Commercial |
$243.94
|
| Rate for Payer: Networks By Design Commercial |
$198.20
|
| Rate for Payer: Prime Health Services Commercial |
$259.18
|
|
|
HC DRSNG QUICKCLOT Z-FOLD
|
Facility
|
OP
|
$304.92
|
|
| Hospital Charge Code |
901608008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$259.18 |
| Rate for Payer: Adventist Health Commercial |
$60.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$187.25
|
| Rate for Payer: Cash Price |
$167.71
|
| Rate for Payer: Cigna of CA HMO |
$195.15
|
| Rate for Payer: Cigna of CA PPO |
$225.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.97
|
| Rate for Payer: EPIC Health Plan Senior |
$121.97
|
| Rate for Payer: Galaxy Health WC |
$259.18
|
| Rate for Payer: Global Benefits Group Commercial |
$182.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.44
|
| Rate for Payer: Multiplan Commercial |
$243.94
|
| Rate for Payer: Networks By Design Commercial |
$198.20
|
| Rate for Payer: Prime Health Services Commercial |
$259.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.46
|
| Rate for Payer: United Healthcare All Other HMO |
$152.46
|
| Rate for Payer: United Healthcare HMO Rider |
$152.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.18
|
| Rate for Payer: Vantage Medical Group Senior |
$259.18
|
|
|
HC DRSNG RENASYS ABD KIT
|
Facility
|
IP
|
$224.70
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Adventist Health Commercial |
$44.94
|
| Rate for Payer: Cash Price |
$123.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.88
|
| Rate for Payer: EPIC Health Plan Senior |
$89.88
|
| Rate for Payer: Galaxy Health WC |
$191.00
|
| Rate for Payer: Global Benefits Group Commercial |
$134.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.93
|
| Rate for Payer: Multiplan Commercial |
$179.76
|
| Rate for Payer: Networks By Design Commercial |
$146.06
|
| Rate for Payer: Prime Health Services Commercial |
$191.00
|
|
|
HC DRSNG RENASYS ABD KIT
|
Facility
|
OP
|
$224.70
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Multiplan Commercial |
$179.76
|
| Rate for Payer: Adventist Health Commercial |
$44.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.99
|
| Rate for Payer: Cash Price |
$123.59
|
| Rate for Payer: Cash Price |
$123.59
|
| Rate for Payer: Cigna of CA HMO |
$143.81
|
| Rate for Payer: Cigna of CA PPO |
$166.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.88
|
| Rate for Payer: EPIC Health Plan Senior |
$89.88
|
| Rate for Payer: Galaxy Health WC |
$191.00
|
| Rate for Payer: Global Benefits Group Commercial |
$134.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.29
|
| Rate for Payer: Networks By Design Commercial |
$146.06
|
| Rate for Payer: Prime Health Services Commercial |
$191.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.35
|
| Rate for Payer: United Healthcare All Other HMO |
$112.35
|
| Rate for Payer: United Healthcare HMO Rider |
$112.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.00
|
| Rate for Payer: Vantage Medical Group Senior |
$191.00
|
|
|
HC DRSNG RENASYS F-FOAM LG KIT
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC DRSNG RENASYS F-FOAM LG KIT
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC DRSNG RENSASYS F-FOAM SM KIT
|
Facility
|
OP
|
$47.48
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$40.36 |
| Rate for Payer: Adventist Health Commercial |
$9.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.16
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cigna of CA HMO |
$30.39
|
| Rate for Payer: Cigna of CA PPO |
$35.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: EPIC Health Plan Senior |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.24
|
| Rate for Payer: Multiplan Commercial |
$37.98
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.74
|
| Rate for Payer: United Healthcare All Other HMO |
$23.74
|
| Rate for Payer: United Healthcare HMO Rider |
$23.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.36
|
| Rate for Payer: Vantage Medical Group Senior |
$40.36
|
|
