|
HC DRSNG VAC ACTICOAT FLEX 3 4X4
|
Facility
|
OP
|
$102.60
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Adventist Health Commercial |
$20.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.01
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cigna of CA HMO |
$65.66
|
| Rate for Payer: Cigna of CA PPO |
$75.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.04
|
| Rate for Payer: EPIC Health Plan Senior |
$41.04
|
| Rate for Payer: Galaxy Health WC |
$87.21
|
| Rate for Payer: Global Benefits Group Commercial |
$61.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.82
|
| Rate for Payer: Multiplan Commercial |
$82.08
|
| Rate for Payer: Networks By Design Commercial |
$66.69
|
| Rate for Payer: Prime Health Services Commercial |
$87.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.30
|
| Rate for Payer: United Healthcare All Other HMO |
$51.30
|
| Rate for Payer: United Healthcare HMO Rider |
$51.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.21
|
| Rate for Payer: Vantage Medical Group Senior |
$87.21
|
|
|
HC DRSNG VAC GAUZE ROLL LRG ANTIM
|
Facility
|
OP
|
$60.76
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$51.65 |
| Rate for Payer: Adventist Health Commercial |
$12.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.31
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cigna of CA HMO |
$38.89
|
| Rate for Payer: Cigna of CA PPO |
$44.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Senior |
$24.30
|
| Rate for Payer: Galaxy Health WC |
$51.65
|
| Rate for Payer: Global Benefits Group Commercial |
$36.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.53
|
| Rate for Payer: Multiplan Commercial |
$48.61
|
| Rate for Payer: Networks By Design Commercial |
$39.49
|
| Rate for Payer: Prime Health Services Commercial |
$51.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.38
|
| Rate for Payer: United Healthcare All Other HMO |
$30.38
|
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.65
|
| Rate for Payer: Vantage Medical Group Senior |
$51.65
|
|
|
HC DRSNG VAC GAUZE ROLL LRG ANTIM
|
Facility
|
IP
|
$60.76
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$51.65 |
| Rate for Payer: Adventist Health Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Senior |
$24.30
|
| Rate for Payer: Galaxy Health WC |
$51.65
|
| Rate for Payer: Global Benefits Group Commercial |
$36.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.58
|
| Rate for Payer: Multiplan Commercial |
$48.61
|
| Rate for Payer: Networks By Design Commercial |
$39.49
|
| Rate for Payer: Prime Health Services Commercial |
$51.65
|
|
|
HC DRSNG VAC RESTORE AG 4X5
|
Facility
|
OP
|
$62.73
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901606110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$53.32 |
| Rate for Payer: Adventist Health Commercial |
$12.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.52
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna of CA HMO |
$40.15
|
| Rate for Payer: Cigna of CA PPO |
$46.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.09
|
| Rate for Payer: EPIC Health Plan Senior |
$25.09
|
| Rate for Payer: Galaxy Health WC |
$53.32
|
| Rate for Payer: Global Benefits Group Commercial |
$37.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.91
|
| Rate for Payer: Multiplan Commercial |
$50.18
|
| Rate for Payer: Networks By Design Commercial |
$40.77
|
| Rate for Payer: Prime Health Services Commercial |
$53.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.36
|
| Rate for Payer: United Healthcare All Other HMO |
$31.36
|
| Rate for Payer: United Healthcare HMO Rider |
$31.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.32
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
|
|
HC DRSNG VAC RESTORE AG 4X5
|
Facility
|
IP
|
$62.73
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901606110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$53.32 |
| Rate for Payer: Adventist Health Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.09
|
| Rate for Payer: EPIC Health Plan Senior |
$25.09
|
| Rate for Payer: Galaxy Health WC |
$53.32
|
| Rate for Payer: Global Benefits Group Commercial |
$37.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.06
|
| Rate for Payer: Multiplan Commercial |
$50.18
|
| Rate for Payer: Networks By Design Commercial |
$40.77
|
| Rate for Payer: Prime Health Services Commercial |
$53.32
|
|
|
HC DRSNG VAC VERAFLO CLEANSE MED
|
Facility
|
OP
|
$633.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$538.53 |
| Rate for Payer: Adventist Health Commercial |
$126.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$415.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$389.07
|
| Rate for Payer: Cash Price |
$348.46
|
| Rate for Payer: Cash Price |
$348.46
|
| Rate for Payer: Cigna of CA HMO |
$405.48
|
| Rate for Payer: Cigna of CA PPO |
$468.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.42
|
| Rate for Payer: EPIC Health Plan Senior |
$253.42
|
| Rate for Payer: Galaxy Health WC |
$538.53
|
| Rate for Payer: Global Benefits Group Commercial |
$380.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$443.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$443.49
|
| Rate for Payer: Multiplan Commercial |
$506.85
|
| Rate for Payer: Networks By Design Commercial |
$411.81
|
| Rate for Payer: Prime Health Services Commercial |
$538.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.78
|
| Rate for Payer: United Healthcare All Other HMO |
$316.78
|
| Rate for Payer: United Healthcare HMO Rider |
$316.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$316.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$538.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.53
|
| Rate for Payer: Vantage Medical Group Senior |
$538.53
|
|
|
HC DRSNG VAC VERAFLO CLEANSE MED
|
Facility
|
IP
|
$633.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.71 |
| Max. Negotiated Rate |
$538.53 |
| Rate for Payer: Adventist Health Commercial |
$126.71
|
| Rate for Payer: Cash Price |
$348.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.42
|
| Rate for Payer: EPIC Health Plan Senior |
$253.42
|
| Rate for Payer: Galaxy Health WC |
$538.53
|
| Rate for Payer: Global Benefits Group Commercial |
$380.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.05
|
| Rate for Payer: Multiplan Commercial |
$506.85
|
| Rate for Payer: Networks By Design Commercial |
$411.81
|
| Rate for Payer: Prime Health Services Commercial |
$538.53
|
|
|
HC DRSNG WND ADHESV RENASYS GEL P
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$35.55 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.68
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna of CA HMO |
$26.76
|
| Rate for Payer: Cigna of CA PPO |
$30.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.73
|
| Rate for Payer: Galaxy Health WC |
$35.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.27
|
| Rate for Payer: Multiplan Commercial |
$33.46
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.55
|
| Rate for Payer: Vantage Medical Group Senior |
$35.55
|
|
|
HC DRSNG WND ADHESV RENASYS GEL P
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$35.55 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.73
|
| Rate for Payer: Galaxy Health WC |
$35.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$33.46
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.55
|
|
|
HC DRSNG WOUND 3.6 X 8" MEDPORE
|
Facility
|
OP
|
$7.79
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901698618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.78
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cigna of CA HMO |
$4.99
|
| Rate for Payer: Cigna of CA PPO |
$5.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.45
|
| Rate for Payer: Multiplan Commercial |
$6.23
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.62
|
| Rate for Payer: Vantage Medical Group Senior |
$6.62
|
|
|
HC DRSNG WOUND 3.6 X 8" MEDPORE
|
Facility
|
IP
|
$7.79
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901698618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$6.23
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
|
|
HC DRSNG WOUND ANASEPT GEL 3OZ
|
Facility
|
OP
|
$182.21
|
|
| Hospital Charge Code |
901698215
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.44 |
| Max. Negotiated Rate |
$154.88 |
| Rate for Payer: Adventist Health Commercial |
$36.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.90
|
| Rate for Payer: Cash Price |
$100.22
|
| Rate for Payer: Cigna of CA HMO |
$116.61
|
| Rate for Payer: Cigna of CA PPO |
$134.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.88
|
| Rate for Payer: EPIC Health Plan Senior |
$72.88
|
| Rate for Payer: Galaxy Health WC |
$154.88
|
| Rate for Payer: Global Benefits Group Commercial |
$109.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.55
|
| Rate for Payer: Multiplan Commercial |
$145.77
|
| Rate for Payer: Networks By Design Commercial |
$118.44
|
| Rate for Payer: Prime Health Services Commercial |
$154.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.11
|
| Rate for Payer: United Healthcare All Other HMO |
$91.11
|
| Rate for Payer: United Healthcare HMO Rider |
$91.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.88
|
| Rate for Payer: Vantage Medical Group Senior |
$154.88
|
|
|
HC DRSNG WOUND ANASEPT GEL 3OZ
|
Facility
|
IP
|
$182.21
|
|
| Hospital Charge Code |
901698215
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.44 |
| Max. Negotiated Rate |
$154.88 |
| Rate for Payer: Adventist Health Commercial |
$36.44
|
| Rate for Payer: Cash Price |
$100.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.88
|
| Rate for Payer: EPIC Health Plan Senior |
$72.88
|
| Rate for Payer: Galaxy Health WC |
$154.88
|
| Rate for Payer: Global Benefits Group Commercial |
$109.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.73
|
| Rate for Payer: Multiplan Commercial |
$145.77
|
| Rate for Payer: Networks By Design Commercial |
$118.44
|
| Rate for Payer: Prime Health Services Commercial |
$154.88
|
|
|
HC DRSNG WOUND BIOPATCH 2CM/4MM
|
Facility
|
IP
|
$54.69
|
|
| Hospital Charge Code |
901605126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$46.49 |
| Rate for Payer: Adventist Health Commercial |
$10.94
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.88
|
| Rate for Payer: EPIC Health Plan Senior |
$21.88
|
| Rate for Payer: Galaxy Health WC |
$46.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.13
|
| Rate for Payer: Multiplan Commercial |
$43.75
|
| Rate for Payer: Networks By Design Commercial |
$35.55
|
| Rate for Payer: Prime Health Services Commercial |
$46.49
|
|
|
HC DRSNG WOUND BIOPATCH 2CM/4MM
|
Facility
|
OP
|
$54.69
|
|
| Hospital Charge Code |
901605126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$46.49 |
| Rate for Payer: Adventist Health Commercial |
$10.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.59
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$40.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.88
|
| Rate for Payer: EPIC Health Plan Senior |
$21.88
|
| Rate for Payer: Galaxy Health WC |
$46.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.28
|
| Rate for Payer: Multiplan Commercial |
$43.75
|
| Rate for Payer: Networks By Design Commercial |
$35.55
|
| Rate for Payer: Prime Health Services Commercial |
$46.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.34
|
| Rate for Payer: United Healthcare All Other HMO |
$27.34
|
| Rate for Payer: United Healthcare HMO Rider |
$27.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.49
|
| Rate for Payer: Vantage Medical Group Senior |
$46.49
|
|
|
HC DRSNG WOUND DURAFIBER AG 4X4
|
Facility
|
IP
|
$61.66
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Adventist Health Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$33.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.66
|
| Rate for Payer: EPIC Health Plan Senior |
$24.66
|
| Rate for Payer: Galaxy Health WC |
$52.41
|
| Rate for Payer: Global Benefits Group Commercial |
$37.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Multiplan Commercial |
$49.33
|
| Rate for Payer: Networks By Design Commercial |
$40.08
|
| Rate for Payer: Prime Health Services Commercial |
$52.41
|
|
|
HC DRSNG WOUND DURAFIBER AG 4X4
|
Facility
|
OP
|
$61.66
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Adventist Health Commercial |
$12.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.87
|
| Rate for Payer: Cash Price |
$33.91
|
| Rate for Payer: Cigna of CA HMO |
$39.46
|
| Rate for Payer: Cigna of CA PPO |
$45.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.66
|
| Rate for Payer: EPIC Health Plan Senior |
$24.66
|
| Rate for Payer: Galaxy Health WC |
$52.41
|
| Rate for Payer: Global Benefits Group Commercial |
$37.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.16
|
| Rate for Payer: Multiplan Commercial |
$49.33
|
| Rate for Payer: Networks By Design Commercial |
$40.08
|
| Rate for Payer: Prime Health Services Commercial |
$52.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.83
|
| Rate for Payer: United Healthcare All Other HMO |
$30.83
|
| Rate for Payer: United Healthcare HMO Rider |
$30.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.41
|
| Rate for Payer: Vantage Medical Group Senior |
$52.41
|
|
|
HC DRSNG WOUND ES PLUS AG RIBBON
|
Facility
|
OP
|
$74.78
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901698127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$63.56 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.92
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cigna of CA HMO |
$47.86
|
| Rate for Payer: Cigna of CA PPO |
$55.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.35
|
| Rate for Payer: Multiplan Commercial |
$59.82
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.39
|
| Rate for Payer: United Healthcare All Other HMO |
$37.39
|
| Rate for Payer: United Healthcare HMO Rider |
$37.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.56
|
| Rate for Payer: Vantage Medical Group Senior |
$63.56
|
|
|
HC DRSNG WOUND ES PLUS AG RIBBON
|
Facility
|
IP
|
$74.78
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901698127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$63.56 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: Multiplan Commercial |
$59.82
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
|
|
HC DRSNG WOUND GAUZE ADH 4X14"
|
Facility
|
OP
|
$6.97
|
|
| Hospital Charge Code |
901698919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.28
|
| Rate for Payer: Cash Price |
$3.83
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$5.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$5.58
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.92
|
| Rate for Payer: Vantage Medical Group Senior |
$5.92
|
|
|
HC DRSNG WOUND GAUZE ADH 4X14"
|
Facility
|
IP
|
$6.97
|
|
| Hospital Charge Code |
901698919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Cash Price |
$3.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$5.58
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
|
|
HC DRSNG WOUND INTERDRY
|
Facility
|
IP
|
$338.45
|
|
| Hospital Charge Code |
901605294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$287.68 |
| Rate for Payer: Adventist Health Commercial |
$67.69
|
| Rate for Payer: Cash Price |
$186.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.38
|
| Rate for Payer: EPIC Health Plan Senior |
$135.38
|
| Rate for Payer: Galaxy Health WC |
$287.68
|
| Rate for Payer: Global Benefits Group Commercial |
$203.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.23
|
| Rate for Payer: Multiplan Commercial |
$270.76
|
| Rate for Payer: Networks By Design Commercial |
$219.99
|
| Rate for Payer: Prime Health Services Commercial |
$287.68
|
|
|
HC DRSNG WOUND INTERDRY
|
Facility
|
OP
|
$338.45
|
|
| Hospital Charge Code |
901605294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$287.68 |
| Rate for Payer: Adventist Health Commercial |
$67.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$287.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$253.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.84
|
| Rate for Payer: Cash Price |
$186.15
|
| Rate for Payer: Cigna of CA HMO |
$216.61
|
| Rate for Payer: Cigna of CA PPO |
$250.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$287.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$287.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$287.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.38
|
| Rate for Payer: EPIC Health Plan Senior |
$135.38
|
| Rate for Payer: Galaxy Health WC |
$287.68
|
| Rate for Payer: Global Benefits Group Commercial |
$203.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$236.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$236.91
|
| Rate for Payer: Multiplan Commercial |
$270.76
|
| Rate for Payer: Networks By Design Commercial |
$219.99
|
| Rate for Payer: Prime Health Services Commercial |
$287.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.22
|
| Rate for Payer: United Healthcare All Other HMO |
$169.22
|
| Rate for Payer: United Healthcare HMO Rider |
$169.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$169.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$287.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$287.68
|
| Rate for Payer: Vantage Medical Group Senior |
$287.68
|
|
|
HC DRSNG WOUND MEPILEX 8X8"
|
Facility
|
OP
|
$210.84
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901695705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$179.21 |
| Rate for Payer: Adventist Health Commercial |
$42.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.48
|
| Rate for Payer: Cash Price |
$115.96
|
| Rate for Payer: Cigna of CA HMO |
$134.94
|
| Rate for Payer: Cigna of CA PPO |
$156.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$179.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$179.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.34
|
| Rate for Payer: EPIC Health Plan Senior |
$84.34
|
| Rate for Payer: Galaxy Health WC |
$179.21
|
| Rate for Payer: Global Benefits Group Commercial |
$126.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.59
|
| Rate for Payer: Multiplan Commercial |
$168.67
|
| Rate for Payer: Networks By Design Commercial |
$137.05
|
| Rate for Payer: Prime Health Services Commercial |
$179.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.42
|
| Rate for Payer: United Healthcare All Other HMO |
$105.42
|
| Rate for Payer: United Healthcare HMO Rider |
$105.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$179.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$179.21
|
| Rate for Payer: Vantage Medical Group Senior |
$179.21
|
|
|
HC DRSNG WOUND MEPILEX 8X8"
|
Facility
|
IP
|
$210.84
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901695705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$179.21 |
| Rate for Payer: Adventist Health Commercial |
$42.17
|
| Rate for Payer: Cash Price |
$115.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.34
|
| Rate for Payer: EPIC Health Plan Senior |
$84.34
|
| Rate for Payer: Galaxy Health WC |
$179.21
|
| Rate for Payer: Global Benefits Group Commercial |
$126.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$168.67
|
| Rate for Payer: Networks By Design Commercial |
$137.05
|
| Rate for Payer: Prime Health Services Commercial |
$179.21
|
|
