|
HC DRSNG WOUND MEPLIX LITE 4X4
|
Facility
|
OP
|
$23.69
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901692023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$20.14 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.55
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: Cigna of CA HMO |
$15.16
|
| Rate for Payer: Cigna of CA PPO |
$17.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.58
|
| Rate for Payer: Multiplan Commercial |
$18.95
|
| Rate for Payer: Networks By Design Commercial |
$15.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.85
|
| Rate for Payer: United Healthcare All Other HMO |
$11.85
|
| Rate for Payer: United Healthcare HMO Rider |
$11.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.14
|
| Rate for Payer: Vantage Medical Group Senior |
$20.14
|
|
|
HC DRSNG WOUND MEPLIX LITE 4X4
|
Facility
|
IP
|
$23.69
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901692023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$20.14 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$18.95
|
| Rate for Payer: Networks By Design Commercial |
$15.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.14
|
|
|
HC DRSNG WOUND MEPORE 3.5"X6"
|
Facility
|
OP
|
$5.25
|
|
| Hospital Charge Code |
901604798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.22
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$3.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Senior |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$4.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Prime Health Services Commercial |
$4.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.46
|
| Rate for Payer: Vantage Medical Group Senior |
$4.46
|
|
|
HC DRSNG WOUND MEPORE 3.5"X6"
|
Facility
|
IP
|
$5.25
|
|
| Hospital Charge Code |
901604798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Senior |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$4.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Prime Health Services Commercial |
$4.46
|
|
|
HC DRSNG WOUND NON-ADHSV 6.125X8"
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901607859
|
|
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 WOUND NON-ADHSV 6.125X8"
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901607859
|
|
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 WOUND VAC ATS SMALL
|
Facility
|
OP
|
$225.96
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$192.07 |
| Rate for Payer: Adventist Health Commercial |
$45.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.76
|
| Rate for Payer: Cash Price |
$124.28
|
| Rate for Payer: Cash Price |
$124.28
|
| Rate for Payer: Cigna of CA HMO |
$144.61
|
| Rate for Payer: Cigna of CA PPO |
$167.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.38
|
| Rate for Payer: EPIC Health Plan Senior |
$90.38
|
| Rate for Payer: Galaxy Health WC |
$192.07
|
| Rate for Payer: Global Benefits Group Commercial |
$135.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.17
|
| Rate for Payer: Multiplan Commercial |
$180.77
|
| Rate for Payer: Networks By Design Commercial |
$146.87
|
| Rate for Payer: Prime Health Services Commercial |
$192.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.98
|
| Rate for Payer: United Healthcare All Other HMO |
$112.98
|
| Rate for Payer: United Healthcare HMO Rider |
$112.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.07
|
| Rate for Payer: Vantage Medical Group Senior |
$192.07
|
|
|
HC DRSNG WOUND VAC ATS SMALL
|
Facility
|
IP
|
$225.96
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$192.07 |
| Rate for Payer: Adventist Health Commercial |
$45.19
|
| Rate for Payer: Cash Price |
$124.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.38
|
| Rate for Payer: EPIC Health Plan Senior |
$90.38
|
| Rate for Payer: Galaxy Health WC |
$192.07
|
| Rate for Payer: Global Benefits Group Commercial |
$135.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.23
|
| Rate for Payer: Multiplan Commercial |
$180.77
|
| Rate for Payer: Networks By Design Commercial |
$146.87
|
| Rate for Payer: Prime Health Services Commercial |
$192.07
|
|
|
HC DRSNG WOUND VAC LG
|
Facility
|
OP
|
$343.77
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$292.20 |
| Rate for Payer: Adventist Health Commercial |
$68.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$225.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$189.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$257.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.11
|
| Rate for Payer: Cash Price |
$189.07
|
| Rate for Payer: Cash Price |
$189.07
|
| Rate for Payer: Cigna of CA HMO |
$220.01
|
| Rate for Payer: Cigna of CA PPO |
$254.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$292.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$292.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.51
|
| Rate for Payer: EPIC Health Plan Senior |
$137.51
|
| Rate for Payer: Galaxy Health WC |
$292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$206.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$212.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$240.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$240.64
|
| Rate for Payer: Multiplan Commercial |
$275.02
|
| Rate for Payer: Networks By Design Commercial |
$223.45
|
| Rate for Payer: Prime Health Services Commercial |
$292.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$206.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$206.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.88
|
| Rate for Payer: United Healthcare All Other HMO |
$171.88
|
| Rate for Payer: United Healthcare HMO Rider |
$171.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$292.20
|
| Rate for Payer: Vantage Medical Group Senior |
$292.20
|
|
|
HC DRSNG WOUND VAC LG
|
Facility
|
IP
|
$343.77
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$292.20 |
| Rate for Payer: Adventist Health Commercial |
$68.75
|
| Rate for Payer: Cash Price |
$189.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.51
|
| Rate for Payer: EPIC Health Plan Senior |
$137.51
|
| Rate for Payer: Galaxy Health WC |
$292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$206.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$212.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$275.02
|
| Rate for Payer: Networks By Design Commercial |
$223.45
|
| Rate for Payer: Prime Health Services Commercial |
$292.20
|
|
|
HC DRSNG WOUND VAC MED BLACK
|
Facility
|
IP
|
$279.16
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Adventist Health Commercial |
$55.83
|
| Rate for Payer: Cash Price |
$153.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.66
|
| Rate for Payer: EPIC Health Plan Senior |
$111.66
|
| Rate for Payer: Galaxy Health WC |
$237.29
|
| Rate for Payer: Global Benefits Group Commercial |
$167.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$223.33
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$237.29
|
|
|
HC DRSNG WOUND VAC MED BLACK
|
Facility
|
OP
|
$279.16
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Adventist Health Commercial |
$55.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$237.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.43
|
| Rate for Payer: Cash Price |
$153.54
|
| Rate for Payer: Cash Price |
$153.54
|
| Rate for Payer: Cigna of CA HMO |
$178.66
|
| Rate for Payer: Cigna of CA PPO |
$206.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$237.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$237.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$237.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.66
|
| Rate for Payer: EPIC Health Plan Senior |
$111.66
|
| Rate for Payer: Galaxy Health WC |
$237.29
|
| Rate for Payer: Global Benefits Group Commercial |
$167.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$195.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$195.41
|
| Rate for Payer: Multiplan Commercial |
$223.33
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$237.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$167.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$167.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.58
|
| Rate for Payer: United Healthcare All Other HMO |
$139.58
|
| Rate for Payer: United Healthcare HMO Rider |
$139.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$237.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$237.29
|
| Rate for Payer: Vantage Medical Group Senior |
$237.29
|
|
|
HC DRSNG WOUND VAC MED SLVR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901609001
|
|
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 WOUND VAC MED SLVR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901609001
|
|
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 WOUND VAC THIN
|
Facility
|
IP
|
$364.82
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$310.10 |
| Rate for Payer: Adventist Health Commercial |
$72.96
|
| Rate for Payer: Cash Price |
$200.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.93
|
| Rate for Payer: EPIC Health Plan Senior |
$145.93
|
| Rate for Payer: Galaxy Health WC |
$310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$218.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.56
|
| Rate for Payer: Multiplan Commercial |
$291.86
|
| Rate for Payer: Networks By Design Commercial |
$237.13
|
| Rate for Payer: Prime Health Services Commercial |
$310.10
|
|
|
HC DRSNG WOUND VAC THIN
|
Facility
|
OP
|
$364.82
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$310.10 |
| Rate for Payer: Adventist Health Commercial |
$72.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$239.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.04
|
| Rate for Payer: Cash Price |
$200.65
|
| Rate for Payer: Cash Price |
$200.65
|
| Rate for Payer: Cigna of CA HMO |
$233.48
|
| Rate for Payer: Cigna of CA PPO |
$269.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$310.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.93
|
| Rate for Payer: EPIC Health Plan Senior |
$145.93
|
| Rate for Payer: Galaxy Health WC |
$310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$218.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$255.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$255.37
|
| Rate for Payer: Multiplan Commercial |
$291.86
|
| Rate for Payer: Networks By Design Commercial |
$237.13
|
| Rate for Payer: Prime Health Services Commercial |
$310.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.41
|
| Rate for Payer: United Healthcare All Other HMO |
$182.41
|
| Rate for Payer: United Healthcare HMO Rider |
$182.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$182.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.10
|
| Rate for Payer: Vantage Medical Group Senior |
$310.10
|
|
|
HC DRSNG WOUND VAC VERAFLO LRG
|
Facility
|
OP
|
$983.85
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$836.27 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$645.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$604.18
|
| Rate for Payer: Cash Price |
$541.12
|
| Rate for Payer: Cash Price |
$541.12
|
| Rate for Payer: Cigna of CA HMO |
$629.66
|
| Rate for Payer: Cigna of CA PPO |
$728.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$836.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$836.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$836.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$688.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.70
|
| Rate for Payer: Multiplan Commercial |
$787.08
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.93
|
| Rate for Payer: United Healthcare All Other HMO |
$491.93
|
| Rate for Payer: United Healthcare HMO Rider |
$491.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$836.27
|
| Rate for Payer: Vantage Medical Group Senior |
$836.27
|
|
|
HC DRSNG WOUND VAC VERAFLO LRG
|
Facility
|
IP
|
$983.85
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$836.27 |
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Cash Price |
$541.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.12
|
| Rate for Payer: Multiplan Commercial |
$787.08
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
|
|
HC DRSNG WOUND VAC VERAFLO MED
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC DRSNG WOUND VAC VERAFLO MED
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC DRSNG WOUND VAC WHITE LG
|
Facility
|
IP
|
$91.28
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$77.59 |
| Rate for Payer: Adventist Health Commercial |
$18.26
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.51
|
| Rate for Payer: EPIC Health Plan Senior |
$36.51
|
| Rate for Payer: Galaxy Health WC |
$77.59
|
| Rate for Payer: Global Benefits Group Commercial |
$54.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.91
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$59.33
|
| Rate for Payer: Prime Health Services Commercial |
$77.59
|
|
|
HC DRSNG WOUND VAC WHITE LG
|
Facility
|
OP
|
$91.28
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$77.59 |
| Rate for Payer: Adventist Health Commercial |
$18.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.06
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Cash Price |
$50.20
|
| Rate for Payer: Cigna of CA HMO |
$58.42
|
| Rate for Payer: Cigna of CA PPO |
$67.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.51
|
| Rate for Payer: EPIC Health Plan Senior |
$36.51
|
| Rate for Payer: Galaxy Health WC |
$77.59
|
| Rate for Payer: Global Benefits Group Commercial |
$54.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.90
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$59.33
|
| Rate for Payer: Prime Health Services Commercial |
$77.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.64
|
| Rate for Payer: United Healthcare All Other HMO |
$45.64
|
| Rate for Payer: United Healthcare HMO Rider |
$45.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.59
|
| Rate for Payer: Vantage Medical Group Senior |
$77.59
|
|
|
HC DRSNG WOUND VAC WHITE SM
|
Facility
|
OP
|
$79.29
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$67.40 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.40
|
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.69
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cigna of CA HMO |
$50.75
|
| Rate for Payer: Cigna of CA PPO |
$58.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.72
|
| Rate for Payer: EPIC Health Plan Senior |
$31.72
|
| Rate for Payer: Galaxy Health WC |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.50
|
| Rate for Payer: Multiplan Commercial |
$63.43
|
| Rate for Payer: Networks By Design Commercial |
$51.54
|
| Rate for Payer: Prime Health Services Commercial |
$67.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.65
|
| Rate for Payer: United Healthcare All Other HMO |
$39.65
|
| Rate for Payer: United Healthcare HMO Rider |
$39.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.40
|
| Rate for Payer: Vantage Medical Group Senior |
$67.40
|
|
|
HC DRSNG WOUND VAC WHITE SM
|
Facility
|
IP
|
$79.29
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$67.40 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.72
|
| Rate for Payer: EPIC Health Plan Senior |
$31.72
|
| Rate for Payer: Galaxy Health WC |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.03
|
| Rate for Payer: Multiplan Commercial |
$63.43
|
| Rate for Payer: Networks By Design Commercial |
$51.54
|
| Rate for Payer: Prime Health Services Commercial |
$67.40
|
|
|
HC DRSNG WOUND VAC XLG
|
Facility
|
IP
|
$548.74
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901692012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.75 |
| Max. Negotiated Rate |
$466.43 |
| Rate for Payer: Adventist Health Commercial |
$109.75
|
| Rate for Payer: Cash Price |
$301.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.50
|
| Rate for Payer: EPIC Health Plan Senior |
$219.50
|
| Rate for Payer: Galaxy Health WC |
$466.43
|
| Rate for Payer: Global Benefits Group Commercial |
$329.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.70
|
| Rate for Payer: Multiplan Commercial |
$438.99
|
| Rate for Payer: Networks By Design Commercial |
$356.68
|
| Rate for Payer: Prime Health Services Commercial |
$466.43
|
|
