|
HC DRSNG RENSASYS F-FOAM SM KIT
|
Facility
|
IP
|
$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: Cash Price |
$26.11
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.09
|
| 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: Multiplan Commercial |
$37.98
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
|
|
HC DRSNG SHEET 2X2 HD THERAHONEY
|
Facility
|
OP
|
$29.19
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901698902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$24.81 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.93
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cigna of CA HMO |
$18.68
|
| Rate for Payer: Cigna of CA PPO |
$21.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11.68
|
| Rate for Payer: Galaxy Health WC |
$24.81
|
| Rate for Payer: Global Benefits Group Commercial |
$17.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.43
|
| Rate for Payer: Multiplan Commercial |
$23.35
|
| Rate for Payer: Networks By Design Commercial |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$24.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.60
|
| Rate for Payer: United Healthcare All Other HMO |
$14.60
|
| Rate for Payer: United Healthcare HMO Rider |
$14.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.81
|
|
|
HC DRSNG SHEET 2X2 HD THERAHONEY
|
Facility
|
IP
|
$29.19
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901698902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$24.81 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11.68
|
| Rate for Payer: Galaxy Health WC |
$24.81
|
| Rate for Payer: Global Benefits Group Commercial |
$17.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$23.35
|
| Rate for Payer: Networks By Design Commercial |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$24.81
|
|
|
HC DRSNG SHEET 4X5 HD THERAHONEY
|
Facility
|
IP
|
$66.34
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$56.39 |
| Rate for Payer: Adventist Health Commercial |
$13.27
|
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.54
|
| Rate for Payer: EPIC Health Plan Senior |
$26.54
|
| Rate for Payer: Galaxy Health WC |
$56.39
|
| Rate for Payer: Global Benefits Group Commercial |
$39.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.92
|
| Rate for Payer: Multiplan Commercial |
$53.07
|
| Rate for Payer: Networks By Design Commercial |
$43.12
|
| Rate for Payer: Prime Health Services Commercial |
$56.39
|
|
|
HC DRSNG SHEET 4X5 HD THERAHONEY
|
Facility
|
OP
|
$66.34
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$56.39 |
| Rate for Payer: Adventist Health Commercial |
$13.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.74
|
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: Cigna of CA HMO |
$42.46
|
| Rate for Payer: Cigna of CA PPO |
$49.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.54
|
| Rate for Payer: EPIC Health Plan Senior |
$26.54
|
| Rate for Payer: Galaxy Health WC |
$56.39
|
| Rate for Payer: Global Benefits Group Commercial |
$39.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.44
|
| Rate for Payer: Multiplan Commercial |
$53.07
|
| Rate for Payer: Networks By Design Commercial |
$43.12
|
| Rate for Payer: Prime Health Services Commercial |
$56.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.17
|
| Rate for Payer: United Healthcare All Other HMO |
$33.17
|
| Rate for Payer: United Healthcare HMO Rider |
$33.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.39
|
| Rate for Payer: Vantage Medical Group Senior |
$56.39
|
|
|
HC DRSNG SHEET 4X5 THERAHONEY
|
Facility
|
IP
|
$48.79
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Adventist Health Commercial |
$9.76
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.52
|
| Rate for Payer: EPIC Health Plan Senior |
$19.52
|
| Rate for Payer: Galaxy Health WC |
$41.47
|
| Rate for Payer: Global Benefits Group Commercial |
$29.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.71
|
| Rate for Payer: Multiplan Commercial |
$39.03
|
| Rate for Payer: Networks By Design Commercial |
$31.71
|
| Rate for Payer: Prime Health Services Commercial |
$41.47
|
|
|
HC DRSNG SHEET 4X5 THERAHONEY
|
Facility
|
OP
|
$48.79
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Adventist Health Commercial |
$9.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.96
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cigna of CA HMO |
$31.23
|
| Rate for Payer: Cigna of CA PPO |
$36.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.52
|
| Rate for Payer: EPIC Health Plan Senior |
$19.52
|
| Rate for Payer: Galaxy Health WC |
$41.47
|
| Rate for Payer: Global Benefits Group Commercial |
$29.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.15
|
| Rate for Payer: Multiplan Commercial |
$39.03
|
| Rate for Payer: Networks By Design Commercial |
$31.71
|
| Rate for Payer: Prime Health Services Commercial |
$41.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.39
|
| Rate for Payer: United Healthcare All Other HMO |
$24.39
|
| Rate for Payer: United Healthcare HMO Rider |
$24.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.47
|
| Rate for Payer: Vantage Medical Group Senior |
$41.47
|
|
|
HC DRSNG SILVASORB SITE 1.75 HRTM
|
Facility
|
OP
|
$50.59
|
|
| Hospital Charge Code |
901692017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Adventist Health Commercial |
$10.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.07
|
| Rate for Payer: Cash Price |
$27.82
|
| Rate for Payer: Cigna of CA HMO |
$32.38
|
| Rate for Payer: Cigna of CA PPO |
$37.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$43.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.41
|
| Rate for Payer: Multiplan Commercial |
$40.47
|
| Rate for Payer: Networks By Design Commercial |
$32.88
|
| Rate for Payer: Prime Health Services Commercial |
$43.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.30
|
| Rate for Payer: United Healthcare All Other HMO |
$25.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.00
|
| Rate for Payer: Vantage Medical Group Senior |
$43.00
|
|
|
HC DRSNG SILVASORB SITE 1.75 HRTM
|
Facility
|
IP
|
$50.59
|
|
| Hospital Charge Code |
901692017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Adventist Health Commercial |
$10.12
|
| Rate for Payer: Cash Price |
$27.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$43.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.14
|
| Rate for Payer: Multiplan Commercial |
$40.47
|
| Rate for Payer: Networks By Design Commercial |
$32.88
|
| Rate for Payer: Prime Health Services Commercial |
$43.00
|
|
|
HC DRSNG SILVER RESTORE 6X8 IN
|
Facility
|
OP
|
$118.64
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.73 |
| Max. Negotiated Rate |
$100.84 |
| Rate for Payer: Adventist Health Commercial |
$23.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.86
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cigna of CA HMO |
$75.93
|
| Rate for Payer: Cigna of CA PPO |
$87.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$100.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.46
|
| Rate for Payer: EPIC Health Plan Senior |
$47.46
|
| Rate for Payer: Galaxy Health WC |
$100.84
|
| Rate for Payer: Global Benefits Group Commercial |
$71.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.05
|
| Rate for Payer: Multiplan Commercial |
$94.91
|
| Rate for Payer: Networks By Design Commercial |
$77.12
|
| Rate for Payer: Prime Health Services Commercial |
$100.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.32
|
| Rate for Payer: United Healthcare All Other HMO |
$59.32
|
| Rate for Payer: United Healthcare HMO Rider |
$59.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.84
|
| Rate for Payer: Vantage Medical Group Senior |
$100.84
|
|
|
HC DRSNG SILVER RESTORE 6X8 IN
|
Facility
|
IP
|
$118.64
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.73 |
| Max. Negotiated Rate |
$100.84 |
| Rate for Payer: Adventist Health Commercial |
$23.73
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.46
|
| Rate for Payer: EPIC Health Plan Senior |
$47.46
|
| Rate for Payer: Galaxy Health WC |
$100.84
|
| Rate for Payer: Global Benefits Group Commercial |
$71.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.47
|
| Rate for Payer: Multiplan Commercial |
$94.91
|
| Rate for Payer: Networks By Design Commercial |
$77.12
|
| Rate for Payer: Prime Health Services Commercial |
$100.84
|
|
|
HC DRSNG SILVERSORB 1" ROUND
|
Facility
|
IP
|
$25.58
|
|
| Hospital Charge Code |
901692011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Adventist Health Commercial |
$5.12
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.23
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$21.74
|
| Rate for Payer: Global Benefits Group Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.14
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: Networks By Design Commercial |
$16.63
|
| Rate for Payer: Prime Health Services Commercial |
$21.74
|
|
|
HC DRSNG SILVERSORB 1" ROUND
|
Facility
|
OP
|
$25.58
|
|
| Hospital Charge Code |
901692011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Adventist Health Commercial |
$5.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.71
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Cigna of CA HMO |
$16.37
|
| Rate for Payer: Cigna of CA PPO |
$18.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.23
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$21.74
|
| Rate for Payer: Global Benefits Group Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.91
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: Networks By Design Commercial |
$16.63
|
| Rate for Payer: Prime Health Services Commercial |
$21.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.79
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Vantage Medical Group Senior |
$21.74
|
|
|
HC DRSNG SILVRCEL ALGINATE 1X12"
|
Facility
|
IP
|
$45.10
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$9.02
|
| Rate for Payer: Cash Price |
$24.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: EPIC Health Plan Senior |
$18.04
|
| Rate for Payer: Galaxy Health WC |
$38.34
|
| Rate for Payer: Global Benefits Group Commercial |
$27.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$36.08
|
| Rate for Payer: Networks By Design Commercial |
$29.32
|
| Rate for Payer: Prime Health Services Commercial |
$38.34
|
|
|
HC DRSNG SILVRCEL ALGINATE 1X12"
|
Facility
|
OP
|
$45.10
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$9.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.70
|
| Rate for Payer: Cash Price |
$24.81
|
| Rate for Payer: Cigna of CA HMO |
$28.86
|
| Rate for Payer: Cigna of CA PPO |
$33.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: EPIC Health Plan Senior |
$18.04
|
| Rate for Payer: Galaxy Health WC |
$38.34
|
| Rate for Payer: Global Benefits Group Commercial |
$27.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.57
|
| Rate for Payer: Multiplan Commercial |
$36.08
|
| Rate for Payer: Networks By Design Commercial |
$29.32
|
| Rate for Payer: Prime Health Services Commercial |
$38.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.55
|
| Rate for Payer: United Healthcare All Other HMO |
$22.55
|
| Rate for Payer: United Healthcare HMO Rider |
$22.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.34
|
| Rate for Payer: Vantage Medical Group Senior |
$38.34
|
|
|
HC DRSNG SLVR ALGINATE 4"X4.75"
|
Facility
|
IP
|
$44.03
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$37.43 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Cash Price |
$24.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.57
|
| Rate for Payer: Multiplan Commercial |
$35.22
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
|
|
HC DRSNG SLVR ALGINATE 4"X4.75"
|
Facility
|
OP
|
$44.03
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$37.43 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.04
|
| Rate for Payer: Cash Price |
$24.22
|
| Rate for Payer: Cigna of CA HMO |
$28.18
|
| Rate for Payer: Cigna of CA PPO |
$32.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.82
|
| Rate for Payer: Multiplan Commercial |
$35.22
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.02
|
| Rate for Payer: United Healthcare All Other HMO |
$22.02
|
| Rate for Payer: United Healthcare HMO Rider |
$22.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.43
|
| Rate for Payer: Vantage Medical Group Senior |
$37.43
|
|
|
HC DRSNG SLVR AQUACEL AG 3.5X8"
|
Facility
|
OP
|
$251.93
|
|
| Hospital Charge Code |
901698804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$214.14 |
| Rate for Payer: Adventist Health Commercial |
$50.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.71
|
| Rate for Payer: Cash Price |
$138.56
|
| Rate for Payer: Cigna of CA HMO |
$161.24
|
| Rate for Payer: Cigna of CA PPO |
$186.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.77
|
| Rate for Payer: EPIC Health Plan Senior |
$100.77
|
| Rate for Payer: Galaxy Health WC |
$214.14
|
| Rate for Payer: Global Benefits Group Commercial |
$151.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$176.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$176.35
|
| Rate for Payer: Multiplan Commercial |
$201.54
|
| Rate for Payer: Networks By Design Commercial |
$163.75
|
| Rate for Payer: Prime Health Services Commercial |
$214.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.97
|
| Rate for Payer: United Healthcare All Other HMO |
$125.97
|
| Rate for Payer: United Healthcare HMO Rider |
$125.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.14
|
| Rate for Payer: Vantage Medical Group Senior |
$214.14
|
|
|
HC DRSNG SLVR AQUACEL AG 3.5X8"
|
Facility
|
IP
|
$251.93
|
|
| Hospital Charge Code |
901698804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$214.14 |
| Rate for Payer: Adventist Health Commercial |
$50.39
|
| Rate for Payer: Cash Price |
$138.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.77
|
| Rate for Payer: EPIC Health Plan Senior |
$100.77
|
| Rate for Payer: Galaxy Health WC |
$214.14
|
| Rate for Payer: Global Benefits Group Commercial |
$151.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$201.54
|
| Rate for Payer: Networks By Design Commercial |
$163.75
|
| Rate for Payer: Prime Health Services Commercial |
$214.14
|
|
|
HC DRSNG SORBAVIEW 3 X 5
|
Facility
|
IP
|
$13.45
|
|
| Hospital Charge Code |
901604069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Adventist Health Commercial |
$2.69
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Senior |
$5.38
|
| Rate for Payer: Galaxy Health WC |
$11.43
|
| Rate for Payer: Global Benefits Group Commercial |
$8.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: Multiplan Commercial |
$10.76
|
| Rate for Payer: Networks By Design Commercial |
$8.74
|
| Rate for Payer: Prime Health Services Commercial |
$11.43
|
|
|
HC DRSNG SORBAVIEW 3 X 5
|
Facility
|
OP
|
$13.45
|
|
| Hospital Charge Code |
901604069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Adventist Health Commercial |
$2.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.26
|
| Rate for Payer: Cash Price |
$7.40
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$9.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Senior |
$5.38
|
| Rate for Payer: Galaxy Health WC |
$11.43
|
| Rate for Payer: Global Benefits Group Commercial |
$8.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.41
|
| Rate for Payer: Multiplan Commercial |
$10.76
|
| Rate for Payer: Networks By Design Commercial |
$8.74
|
| Rate for Payer: Prime Health Services Commercial |
$11.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.72
|
| Rate for Payer: United Healthcare All Other HMO |
$6.72
|
| Rate for Payer: United Healthcare HMO Rider |
$6.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.43
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
|
|
HC DRSNG SPONGE DRAIN STERILE 2X2"
|
Facility
|
IP
|
$1.07
|
|
| Hospital Charge Code |
901606358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.91
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.91
|
|
|
HC DRSNG SPONGE DRAIN STERILE 2X2"
|
Facility
|
OP
|
$1.07
|
|
| Hospital Charge Code |
901606358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.66
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cigna of CA HMO |
$0.68
|
| Rate for Payer: Cigna of CA PPO |
$0.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.91
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: Vantage Medical Group Senior |
$0.91
|
|
|
HC DRSNG SQUADERM HYDROGEL 4X4
|
Facility
|
IP
|
$19.19
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901698646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$16.31
|
| Rate for Payer: Global Benefits Group Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$15.35
|
| Rate for Payer: Networks By Design Commercial |
$12.47
|
| Rate for Payer: Prime Health Services Commercial |
$16.31
|
|
|
HC DRSNG SQUADERM HYDROGEL 4X4
|
Facility
|
OP
|
$19.19
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901698646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.78
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: Cigna of CA HMO |
$12.28
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$16.31
|
| Rate for Payer: Global Benefits Group Commercial |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.43
|
| Rate for Payer: Multiplan Commercial |
$15.35
|
| Rate for Payer: Networks By Design Commercial |
$12.47
|
| Rate for Payer: Prime Health Services Commercial |
$16.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO |
$9.60
|
| Rate for Payer: United Healthcare HMO Rider |
$9.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.31
|
| Rate for Payer: Vantage Medical Group Senior |
$16.31
|
|
