|
HC DRSNG DUODERM CGF 4X4IN
|
Facility
|
IP
|
$18.20
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698658
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$15.47 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: Multiplan Commercial |
$14.56
|
| Rate for Payer: Networks By Design Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$15.47
|
|
|
HC DRSNG DUODERM CGF 6X6IN
|
Facility
|
OP
|
$130.87
|
|
|
Service Code
|
CPT A6235
|
| Hospital Charge Code |
901698660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$111.24 |
| Rate for Payer: Adventist Health Commercial |
$26.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.98
|
| Rate for Payer: Cash Price |
$58.89
|
| Rate for Payer: Cash Price |
$58.89
|
| Rate for Payer: Cigna of CA HMO |
$83.76
|
| Rate for Payer: Cigna of CA PPO |
$96.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.35
|
| Rate for Payer: EPIC Health Plan Senior |
$52.35
|
| Rate for Payer: Galaxy Health WC |
$111.24
|
| Rate for Payer: Global Benefits Group Commercial |
$78.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.61
|
| Rate for Payer: Multiplan Commercial |
$104.70
|
| Rate for Payer: Networks By Design Commercial |
$85.07
|
| Rate for Payer: Prime Health Services Commercial |
$111.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.44
|
| Rate for Payer: United Healthcare All Other HMO |
$65.44
|
| Rate for Payer: United Healthcare HMO Rider |
$65.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.24
|
| Rate for Payer: Vantage Medical Group Senior |
$111.24
|
|
|
HC DRSNG DUODERM CGF 6X6IN
|
Facility
|
IP
|
$130.87
|
|
|
Service Code
|
CPT A6235
|
| Hospital Charge Code |
901698660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$111.24 |
| Rate for Payer: Adventist Health Commercial |
$26.17
|
| Rate for Payer: Cash Price |
$58.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.35
|
| Rate for Payer: EPIC Health Plan Senior |
$52.35
|
| Rate for Payer: Galaxy Health WC |
$111.24
|
| Rate for Payer: Global Benefits Group Commercial |
$78.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.41
|
| Rate for Payer: Multiplan Commercial |
$104.70
|
| Rate for Payer: Networks By Design Commercial |
$85.07
|
| Rate for Payer: Prime Health Services Commercial |
$111.24
|
|
|
HC DRSNG DUODERM CGF 8X8IN
|
Facility
|
OP
|
$57.32
|
|
|
Service Code
|
CPT A6236
|
| Hospital Charge Code |
901698657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$77.66 |
| Rate for Payer: Adventist Health Commercial |
$11.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.78
|
| Rate for Payer: Cash Price |
$25.79
|
| Rate for Payer: Cash Price |
$25.79
|
| Rate for Payer: Cigna of CA HMO |
$36.68
|
| Rate for Payer: Cigna of CA PPO |
$42.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.93
|
| Rate for Payer: EPIC Health Plan Senior |
$22.93
|
| Rate for Payer: Galaxy Health WC |
$48.72
|
| Rate for Payer: Global Benefits Group Commercial |
$34.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.12
|
| Rate for Payer: Multiplan Commercial |
$45.86
|
| Rate for Payer: Networks By Design Commercial |
$37.26
|
| Rate for Payer: Prime Health Services Commercial |
$48.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.66
|
| Rate for Payer: United Healthcare All Other HMO |
$28.66
|
| Rate for Payer: United Healthcare HMO Rider |
$28.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.72
|
| Rate for Payer: Vantage Medical Group Senior |
$48.72
|
|
|
HC DRSNG DUODERM CGF 8X8IN
|
Facility
|
IP
|
$57.32
|
|
|
Service Code
|
CPT A6236
|
| Hospital Charge Code |
901698657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$48.72 |
| Rate for Payer: Adventist Health Commercial |
$11.46
|
| Rate for Payer: Cash Price |
$25.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.93
|
| Rate for Payer: EPIC Health Plan Senior |
$22.93
|
| Rate for Payer: Galaxy Health WC |
$48.72
|
| Rate for Payer: Global Benefits Group Commercial |
$34.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.76
|
| Rate for Payer: Multiplan Commercial |
$45.86
|
| Rate for Payer: Networks By Design Commercial |
$37.26
|
| Rate for Payer: Prime Health Services Commercial |
$48.72
|
|
|
HC DRSNG EXUDERM THIN HCD 4X4
|
Facility
|
OP
|
$14.27
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901607526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$12.13 |
| Rate for Payer: Adventist Health Commercial |
$2.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.16
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$10.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.71
|
| Rate for Payer: EPIC Health Plan Senior |
$5.71
|
| Rate for Payer: Galaxy Health WC |
$12.13
|
| Rate for Payer: Global Benefits Group Commercial |
$8.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.99
|
| Rate for Payer: Multiplan Commercial |
$11.42
|
| Rate for Payer: Networks By Design Commercial |
$9.28
|
| Rate for Payer: Prime Health Services Commercial |
$12.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.13
|
| Rate for Payer: United Healthcare All Other HMO |
$7.13
|
| Rate for Payer: United Healthcare HMO Rider |
$7.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Vantage Medical Group Senior |
$12.13
|
|
|
HC DRSNG EXUDERM THIN HCD 4X4
|
Facility
|
IP
|
$14.27
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901607526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$12.13 |
| Rate for Payer: Adventist Health Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.71
|
| Rate for Payer: EPIC Health Plan Senior |
$5.71
|
| Rate for Payer: Galaxy Health WC |
$12.13
|
| Rate for Payer: Global Benefits Group Commercial |
$8.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.42
|
| Rate for Payer: Multiplan Commercial |
$11.42
|
| Rate for Payer: Networks By Design Commercial |
$9.28
|
| Rate for Payer: Prime Health Services Commercial |
$12.13
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 4X4
|
Facility
|
OP
|
$53.38
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$45.37 |
| Rate for Payer: Adventist Health Commercial |
$10.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.25
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Cigna of CA HMO |
$34.16
|
| Rate for Payer: Cigna of CA PPO |
$39.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.35
|
| Rate for Payer: EPIC Health Plan Senior |
$21.35
|
| Rate for Payer: Galaxy Health WC |
$45.37
|
| Rate for Payer: Global Benefits Group Commercial |
$32.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.37
|
| Rate for Payer: Multiplan Commercial |
$42.70
|
| Rate for Payer: Networks By Design Commercial |
$34.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.69
|
| Rate for Payer: United Healthcare All Other HMO |
$26.69
|
| Rate for Payer: United Healthcare HMO Rider |
$26.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.37
|
| Rate for Payer: Vantage Medical Group Senior |
$45.37
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 4X4
|
Facility
|
IP
|
$53.38
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$45.37 |
| Rate for Payer: Adventist Health Commercial |
$10.68
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.35
|
| Rate for Payer: EPIC Health Plan Senior |
$21.35
|
| Rate for Payer: Galaxy Health WC |
$45.37
|
| Rate for Payer: Global Benefits Group Commercial |
$32.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.81
|
| Rate for Payer: Multiplan Commercial |
$42.70
|
| Rate for Payer: Networks By Design Commercial |
$34.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.37
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 6X6
|
Facility
|
OP
|
$109.59
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$93.15 |
| Rate for Payer: Adventist Health Commercial |
$21.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.32
|
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Cigna of CA HMO |
$70.14
|
| Rate for Payer: Cigna of CA PPO |
$81.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.84
|
| Rate for Payer: EPIC Health Plan Senior |
$43.84
|
| Rate for Payer: Galaxy Health WC |
$93.15
|
| Rate for Payer: Global Benefits Group Commercial |
$65.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.71
|
| Rate for Payer: Multiplan Commercial |
$87.67
|
| Rate for Payer: Networks By Design Commercial |
$71.23
|
| Rate for Payer: Prime Health Services Commercial |
$93.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.80
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$54.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.15
|
| Rate for Payer: Vantage Medical Group Senior |
$93.15
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 6X6
|
Facility
|
OP
|
$734.80
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$624.58 |
| Rate for Payer: Adventist Health Commercial |
$146.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$624.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$404.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$551.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$471.52
|
| Rate for Payer: Cash Price |
$330.66
|
| Rate for Payer: Cash Price |
$330.66
|
| Rate for Payer: Cigna of CA HMO |
$470.27
|
| Rate for Payer: Cigna of CA PPO |
$543.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$624.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$624.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$514.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.92
|
| Rate for Payer: EPIC Health Plan Senior |
$293.92
|
| Rate for Payer: Galaxy Health WC |
$624.58
|
| Rate for Payer: Global Benefits Group Commercial |
$440.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$466.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$433.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$514.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$514.36
|
| Rate for Payer: Multiplan Commercial |
$587.84
|
| Rate for Payer: Networks By Design Commercial |
$477.62
|
| Rate for Payer: Prime Health Services Commercial |
$624.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$440.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$440.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$367.40
|
| Rate for Payer: United Healthcare All Other HMO |
$367.40
|
| Rate for Payer: United Healthcare HMO Rider |
$367.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$624.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.58
|
| Rate for Payer: Vantage Medical Group Senior |
$624.58
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 6X6
|
Facility
|
IP
|
$734.80
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.96 |
| Max. Negotiated Rate |
$624.58 |
| Rate for Payer: Adventist Health Commercial |
$146.96
|
| Rate for Payer: Cash Price |
$330.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$514.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.92
|
| Rate for Payer: EPIC Health Plan Senior |
$293.92
|
| Rate for Payer: Galaxy Health WC |
$624.58
|
| Rate for Payer: Global Benefits Group Commercial |
$440.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$466.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$433.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.35
|
| Rate for Payer: Multiplan Commercial |
$587.84
|
| Rate for Payer: Networks By Design Commercial |
$477.62
|
| Rate for Payer: Prime Health Services Commercial |
$624.58
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 6X6
|
Facility
|
IP
|
$109.59
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$93.15 |
| Rate for Payer: Adventist Health Commercial |
$21.92
|
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.84
|
| Rate for Payer: EPIC Health Plan Senior |
$43.84
|
| Rate for Payer: Galaxy Health WC |
$93.15
|
| Rate for Payer: Global Benefits Group Commercial |
$65.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.30
|
| Rate for Payer: Multiplan Commercial |
$87.67
|
| Rate for Payer: Networks By Design Commercial |
$71.23
|
| Rate for Payer: Prime Health Services Commercial |
$93.15
|
|
|
HC DRSNG FOAM MEPILEX 3X3" FLEX
|
Facility
|
OP
|
$15.58
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$27.67 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.00
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cigna of CA HMO |
$9.97
|
| Rate for Payer: Cigna of CA PPO |
$11.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Senior |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$12.46
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.79
|
| Rate for Payer: United Healthcare All Other HMO |
$7.79
|
| Rate for Payer: United Healthcare HMO Rider |
$7.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.24
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC DRSNG FOAM MEPILEX 3X3" FLEX
|
Facility
|
IP
|
$15.58
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$13.24 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Senior |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.74
|
| Rate for Payer: Multiplan Commercial |
$12.46
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
|
|
HC DRSNG FOAM MEPILEX 4X4" FLEX
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$16.99
|
| Rate for Payer: Networks By Design Commercial |
$13.81
|
| Rate for Payer: Prime Health Services Commercial |
$18.05
|
|
|
HC DRSNG FOAM MEPILEX 4X4" FLEX
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$27.67 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.63
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cigna of CA HMO |
$13.59
|
| Rate for Payer: Cigna of CA PPO |
$15.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.87
|
| Rate for Payer: Multiplan Commercial |
$16.99
|
| Rate for Payer: Networks By Design Commercial |
$13.81
|
| Rate for Payer: Prime Health Services Commercial |
$18.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.62
|
| Rate for Payer: United Healthcare All Other HMO |
$10.62
|
| Rate for Payer: United Healthcare HMO Rider |
$10.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.05
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
|
|
HC DRSNG FOAM MEPILEX 6X6" FLEX
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$45.81 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.10
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC DRSNG FOAM MEPILEX 6X6" FLEX
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC DRSNG FOAM MEPILEX 6X8" FLEX
|
Facility
|
OP
|
$44.36
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$45.81 |
| Rate for Payer: Adventist Health Commercial |
$8.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.47
|
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Cigna of CA HMO |
$28.39
|
| Rate for Payer: Cigna of CA PPO |
$32.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.74
|
| Rate for Payer: EPIC Health Plan Senior |
$17.74
|
| Rate for Payer: Galaxy Health WC |
$37.71
|
| Rate for Payer: Global Benefits Group Commercial |
$26.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.05
|
| Rate for Payer: Multiplan Commercial |
$35.49
|
| Rate for Payer: Networks By Design Commercial |
$28.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.18
|
| Rate for Payer: United Healthcare All Other HMO |
$22.18
|
| Rate for Payer: United Healthcare HMO Rider |
$22.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.71
|
| Rate for Payer: Vantage Medical Group Senior |
$37.71
|
|
|
HC DRSNG FOAM MEPILEX 6X8" FLEX
|
Facility
|
IP
|
$44.36
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$37.71 |
| Rate for Payer: Adventist Health Commercial |
$8.87
|
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.74
|
| Rate for Payer: EPIC Health Plan Senior |
$17.74
|
| Rate for Payer: Galaxy Health WC |
$37.71
|
| Rate for Payer: Global Benefits Group Commercial |
$26.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.65
|
| Rate for Payer: Multiplan Commercial |
$35.49
|
| Rate for Payer: Networks By Design Commercial |
$28.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.71
|
|
|
HC DRSNG GAUZE NON-ADHERENT 3X3"
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
HC DRSNG GAUZE NON-ADHERENT 3X3"
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
HC DRSNG GAUZE NON-ADHERENT 3X8"
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
|
|
HC DRSNG GAUZE NON-ADHERENT 3X8"
|
Facility
|
OP
|
$2.38
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.53
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$1.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2.02
|
|
