|
HC DRSG AQUACEL HYDROFIBR .75X18"
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| 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 DRSG AQUACEL HYDROFIBR .75X18"
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698528
|
|
Hospital Revenue Code
|
270
|
| 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 |
$52.62
|
| Rate for Payer: Cash Price |
$36.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| 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 DRSG IV ADV CNTL LNE 4X4 3/4IN
|
Facility
|
IP
|
$8.04
|
|
| Hospital Charge Code |
901606218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Senior |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$6.43
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
|
|
HC DRSG IV ADV CNTL LNE 4X4 3/4IN
|
Facility
|
OP
|
$8.04
|
|
| Hospital Charge Code |
901606218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.16
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cigna of CA HMO |
$5.15
|
| Rate for Payer: Cigna of CA PPO |
$5.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Senior |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.63
|
| Rate for Payer: Multiplan Commercial |
$6.43
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.02
|
| Rate for Payer: United Healthcare All Other HMO |
$4.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Vantage Medical Group Senior |
$6.83
|
|
|
HC DRSG POLY 3.5X3.5 NON-ADH FOAM
|
Facility
|
OP
|
$22.80
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$21.27 |
| Rate for Payer: United Healthcare HMO Rider |
$11.40
|
| Rate for Payer: Adventist Health Commercial |
$4.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.63
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cigna of CA HMO |
$14.59
|
| Rate for Payer: Cigna of CA PPO |
$16.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.12
|
| Rate for Payer: EPIC Health Plan Senior |
$9.12
|
| Rate for Payer: Galaxy Health WC |
$19.38
|
| Rate for Payer: Global Benefits Group Commercial |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.96
|
| Rate for Payer: Multiplan Commercial |
$18.24
|
| Rate for Payer: Networks By Design Commercial |
$14.82
|
| Rate for Payer: Prime Health Services Commercial |
$19.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.40
|
| Rate for Payer: United Healthcare All Other HMO |
$11.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.38
|
| Rate for Payer: Vantage Medical Group Senior |
$19.38
|
|
|
HC DRSG POLY 3.5X3.5 NON-ADH FOAM
|
Facility
|
IP
|
$22.80
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$19.38 |
| Rate for Payer: Adventist Health Commercial |
$4.56
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.12
|
| Rate for Payer: EPIC Health Plan Senior |
$9.12
|
| Rate for Payer: Galaxy Health WC |
$19.38
|
| Rate for Payer: Global Benefits Group Commercial |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$18.24
|
| Rate for Payer: Networks By Design Commercial |
$14.82
|
| Rate for Payer: Prime Health Services Commercial |
$19.38
|
|
|
HC DRSG WOUND ADH 4X10 W/2X8" PAD
|
Facility
|
IP
|
$5.90
|
|
| Hospital Charge Code |
901698914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
|
|
HC DRSG WOUND ADH 4X10 W/2X8" PAD
|
Facility
|
OP
|
$5.90
|
|
| Hospital Charge Code |
901698914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.79
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
HC DRSNG ABD ABTHERA SENSATR
|
Facility
|
IP
|
$2,200.64
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.13 |
| Max. Negotiated Rate |
$1,870.54 |
| Rate for Payer: Adventist Health Commercial |
$440.13
|
| Rate for Payer: Cash Price |
$990.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.26
|
| Rate for Payer: EPIC Health Plan Senior |
$880.26
|
| Rate for Payer: Galaxy Health WC |
$1,870.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.15
|
| Rate for Payer: Multiplan Commercial |
$1,760.51
|
| Rate for Payer: Networks By Design Commercial |
$1,430.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.54
|
|
|
HC DRSNG ABD ABTHERA SENSATR
|
Facility
|
OP
|
$2,200.64
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$1,870.54 |
| Rate for Payer: Vantage Medical Group Senior |
$1,870.54
|
| Rate for Payer: Adventist Health Commercial |
$440.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.15
|
| Rate for Payer: Cash Price |
$990.29
|
| Rate for Payer: Cash Price |
$990.29
|
| Rate for Payer: Cigna of CA HMO |
$1,408.41
|
| Rate for Payer: Cigna of CA PPO |
$1,628.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,540.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.26
|
| Rate for Payer: EPIC Health Plan Senior |
$880.26
|
| Rate for Payer: Galaxy Health WC |
$1,870.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,397.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,298.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.45
|
| Rate for Payer: Multiplan Commercial |
$1,760.51
|
| Rate for Payer: Networks By Design Commercial |
$1,430.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,100.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,100.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,100.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,100.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.54
|
|
|
HC DRSNG ABD PAD 8X10IN SINGLE
|
Facility
|
OP
|
$4.18
|
|
| Hospital Charge Code |
901698911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.68
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cigna of CA HMO |
$2.68
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.67
|
| Rate for Payer: EPIC Health Plan Senior |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$3.34
|
| Rate for Payer: Networks By Design Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.09
|
| Rate for Payer: United Healthcare All Other HMO |
$2.09
|
| Rate for Payer: United Healthcare HMO Rider |
$2.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3.55
|
|
|
HC DRSNG ABD PAD 8X10IN SINGLE
|
Facility
|
IP
|
$4.18
|
|
| Hospital Charge Code |
901698911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.67
|
| Rate for Payer: EPIC Health Plan Senior |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.34
|
| Rate for Payer: Networks By Design Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.55
|
|
|
HC DRSNG ABD PAD 8X10IN STRL
|
Facility
|
IP
|
$0.90
|
|
| Hospital Charge Code |
901698913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
|
|
HC DRSNG ABD PAD 8X10IN STRL
|
Facility
|
OP
|
$0.90
|
|
| Hospital Charge Code |
901698913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.58
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.58
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
HC DRSNG ABSORBENT FOAM 4X4 MIPILEX
|
Facility
|
OP
|
$57.15
|
|
| Hospital Charge Code |
901696386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$48.58 |
| Rate for Payer: Adventist Health Commercial |
$11.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.67
|
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Cigna of CA HMO |
$36.58
|
| Rate for Payer: Cigna of CA PPO |
$42.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.86
|
| Rate for Payer: EPIC Health Plan Senior |
$22.86
|
| Rate for Payer: Galaxy Health WC |
$48.58
|
| Rate for Payer: Global Benefits Group Commercial |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.01
|
| Rate for Payer: Multiplan Commercial |
$45.72
|
| Rate for Payer: Networks By Design Commercial |
$37.15
|
| Rate for Payer: Prime Health Services Commercial |
$48.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.57
|
| Rate for Payer: United Healthcare All Other HMO |
$28.57
|
| Rate for Payer: United Healthcare HMO Rider |
$28.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.58
|
| Rate for Payer: Vantage Medical Group Senior |
$48.58
|
|
|
HC DRSNG ABSORBENT FOAM 4X4 MIPILEX
|
Facility
|
IP
|
$57.15
|
|
| Hospital Charge Code |
901696386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$48.58 |
| Rate for Payer: Adventist Health Commercial |
$11.43
|
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.86
|
| Rate for Payer: EPIC Health Plan Senior |
$22.86
|
| Rate for Payer: Galaxy Health WC |
$48.58
|
| Rate for Payer: Global Benefits Group Commercial |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$45.72
|
| Rate for Payer: Networks By Design Commercial |
$37.15
|
| Rate for Payer: Prime Health Services Commercial |
$48.58
|
|
|
HC DRSNG ABSORBNT COMPOSITE 4X10
|
Facility
|
OP
|
$13.12
|
|
| Hospital Charge Code |
901698912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.42
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.18
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.15
|
| Rate for Payer: Vantage Medical Group Senior |
$11.15
|
|
|
HC DRSNG ABSORBNT COMPOSITE 4X10
|
Facility
|
IP
|
$13.12
|
|
| Hospital Charge Code |
901698912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
|
|
HC DRSNG ACTICOAT 4X10 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$210.77
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$179.15 |
| Rate for Payer: Adventist Health Commercial |
$42.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.25
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Cigna of CA HMO |
$134.89
|
| Rate for Payer: Cigna of CA PPO |
$155.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$179.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$179.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.31
|
| Rate for Payer: EPIC Health Plan Senior |
$84.31
|
| Rate for Payer: Galaxy Health WC |
$179.15
|
| Rate for Payer: Global Benefits Group Commercial |
$126.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.54
|
| Rate for Payer: Multiplan Commercial |
$168.62
|
| Rate for Payer: Networks By Design Commercial |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$179.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.39
|
| Rate for Payer: United Healthcare All Other HMO |
$105.39
|
| Rate for Payer: United Healthcare HMO Rider |
$105.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$179.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$179.15
|
| Rate for Payer: Vantage Medical Group Senior |
$179.15
|
|
|
HC DRSNG ACTICOAT 4X10 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$210.77
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$179.15 |
| Rate for Payer: Adventist Health Commercial |
$42.15
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.31
|
| Rate for Payer: EPIC Health Plan Senior |
$84.31
|
| Rate for Payer: Galaxy Health WC |
$179.15
|
| Rate for Payer: Global Benefits Group Commercial |
$126.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.58
|
| Rate for Payer: Multiplan Commercial |
$168.62
|
| Rate for Payer: Networks By Design Commercial |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$179.15
|
|
|
HC DRSNG ACTICOAT 4X13 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$953.07
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901606857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.61 |
| Max. Negotiated Rate |
$810.11 |
| Rate for Payer: Adventist Health Commercial |
$190.61
|
| Rate for Payer: Cash Price |
$428.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$667.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.23
|
| Rate for Payer: EPIC Health Plan Senior |
$381.23
|
| Rate for Payer: Galaxy Health WC |
$810.11
|
| Rate for Payer: Global Benefits Group Commercial |
$571.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$605.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.74
|
| Rate for Payer: Multiplan Commercial |
$762.46
|
| Rate for Payer: Networks By Design Commercial |
$619.50
|
| Rate for Payer: Prime Health Services Commercial |
$810.11
|
|
|
HC DRSNG ACTICOAT 4X13 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$953.07
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901606857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.34 |
| Max. Negotiated Rate |
$810.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29.34
|
| Rate for Payer: Adventist Health Commercial |
$190.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$810.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$524.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$714.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$611.59
|
| Rate for Payer: Cash Price |
$428.88
|
| Rate for Payer: Cash Price |
$428.88
|
| Rate for Payer: Cigna of CA HMO |
$609.96
|
| Rate for Payer: Cigna of CA PPO |
$705.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$810.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$810.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$810.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$667.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.23
|
| Rate for Payer: EPIC Health Plan Senior |
$381.23
|
| Rate for Payer: Galaxy Health WC |
$810.11
|
| Rate for Payer: Global Benefits Group Commercial |
$571.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$605.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$345.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.15
|
| Rate for Payer: Multiplan Commercial |
$762.46
|
| Rate for Payer: Networks By Design Commercial |
$619.50
|
| Rate for Payer: Prime Health Services Commercial |
$810.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$571.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$571.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$476.54
|
| Rate for Payer: United Healthcare All Other HMO |
$476.54
|
| Rate for Payer: United Healthcare HMO Rider |
$476.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$810.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$810.11
|
| Rate for Payer: Vantage Medical Group Senior |
$810.11
|
|
|
HC DRSNG ACTICOAT 4X4 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$134.22
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$114.09 |
| Rate for Payer: Adventist Health Commercial |
$26.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.13
|
| Rate for Payer: Cash Price |
$60.40
|
| Rate for Payer: Cash Price |
$60.40
|
| Rate for Payer: Cigna of CA HMO |
$85.90
|
| Rate for Payer: Cigna of CA PPO |
$99.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.69
|
| Rate for Payer: EPIC Health Plan Senior |
$53.69
|
| Rate for Payer: Galaxy Health WC |
$114.09
|
| Rate for Payer: Global Benefits Group Commercial |
$80.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.95
|
| Rate for Payer: Multiplan Commercial |
$107.38
|
| Rate for Payer: Networks By Design Commercial |
$87.24
|
| Rate for Payer: Prime Health Services Commercial |
$114.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.11
|
| Rate for Payer: United Healthcare All Other HMO |
$67.11
|
| Rate for Payer: United Healthcare HMO Rider |
$67.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.09
|
| Rate for Payer: Vantage Medical Group Senior |
$114.09
|
|
|
HC DRSNG ACTICOAT 4X4 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$134.22
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$114.09 |
| Rate for Payer: Adventist Health Commercial |
$26.84
|
| Rate for Payer: Cash Price |
$60.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.69
|
| Rate for Payer: EPIC Health Plan Senior |
$53.69
|
| Rate for Payer: Galaxy Health WC |
$114.09
|
| Rate for Payer: Global Benefits Group Commercial |
$80.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.21
|
| Rate for Payer: Multiplan Commercial |
$107.38
|
| Rate for Payer: Networks By Design Commercial |
$87.24
|
| Rate for Payer: Prime Health Services Commercial |
$114.09
|
|
|
HC DRSNG ACTICOAT 4X8 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$195.44
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.09 |
| Max. Negotiated Rate |
$166.12 |
| Rate for Payer: Adventist Health Commercial |
$39.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.41
|
| Rate for Payer: Cash Price |
$87.95
|
| Rate for Payer: Cash Price |
$87.95
|
| Rate for Payer: Cigna of CA HMO |
$125.08
|
| Rate for Payer: Cigna of CA PPO |
$144.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.18
|
| Rate for Payer: EPIC Health Plan Senior |
$78.18
|
| Rate for Payer: Galaxy Health WC |
$166.12
|
| Rate for Payer: Global Benefits Group Commercial |
$117.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.81
|
| Rate for Payer: Multiplan Commercial |
$156.35
|
| Rate for Payer: Networks By Design Commercial |
$127.04
|
| Rate for Payer: Prime Health Services Commercial |
$166.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.72
|
| Rate for Payer: United Healthcare All Other HMO |
$97.72
|
| Rate for Payer: United Healthcare HMO Rider |
$97.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.12
|
| Rate for Payer: Vantage Medical Group Senior |
$166.12
|
|
