|
HC DRSNG NON-ADHERENT 3 X 8
|
Facility
|
IP
|
$1.80
|
|
| Hospital Charge Code |
901600311
|
|
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 NON-ADH PAD TELFA 3X4"
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901607908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
|
|
HC DRSNG NON-ADH PAD TELFA 3X4"
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901607908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
|
|
HC DRSNG NON-ADH PAD TELFA 3X8"
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901607909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.42
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
HC DRSNG NON-ADH PAD TELFA 3X8"
|
Facility
|
IP
|
$0.66
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901607909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
|
|
HC DRSNG, OPTIFOAM 4X4IN NON-ADH
|
Facility
|
IP
|
$21.89
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: EPIC Health Plan Senior |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.61
|
| Rate for Payer: Global Benefits Group Commercial |
$13.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$17.51
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
|
|
HC DRSNG, OPTIFOAM 4X4IN NON-ADH
|
Facility
|
OP
|
$21.89
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$21.27 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.05
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cash Price |
$9.85
|
| Rate for Payer: Cigna of CA HMO |
$14.01
|
| Rate for Payer: Cigna of CA PPO |
$16.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: EPIC Health Plan Senior |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.61
|
| Rate for Payer: Global Benefits Group Commercial |
$13.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$17.51
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.61
|
| Rate for Payer: Vantage Medical Group Senior |
$18.61
|
|
|
HC DRSNG, OPTIFOAM 6X6IN NON-ADH
|
Facility
|
OP
|
$36.49
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901607528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$56.80 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.42
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Cigna of CA HMO |
$23.35
|
| Rate for Payer: Cigna of CA PPO |
$27.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.54
|
| Rate for Payer: Multiplan Commercial |
$29.19
|
| Rate for Payer: Networks By Design Commercial |
$23.72
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.25
|
| Rate for Payer: United Healthcare All Other HMO |
$18.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
|
HC DRSNG, OPTIFOAM 6X6IN NON-ADH
|
Facility
|
IP
|
$36.49
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901607528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Multiplan Commercial |
$29.19
|
| Rate for Payer: Networks By Design Commercial |
$23.72
|
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
|
|
HC DRSNG,OPTIFOAM AG 4X4" NON-ADH
|
Facility
|
IP
|
$43.54
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Adventist Health Commercial |
$8.71
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Senior |
$17.42
|
| Rate for Payer: Galaxy Health WC |
$37.01
|
| Rate for Payer: Global Benefits Group Commercial |
$26.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Multiplan Commercial |
$34.83
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$37.01
|
|
|
HC DRSNG,OPTIFOAM AG 4X4" NON-ADH
|
Facility
|
OP
|
$43.54
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Adventist Health Commercial |
$8.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.94
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Cigna of CA HMO |
$27.87
|
| Rate for Payer: Cigna of CA PPO |
$32.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Senior |
$17.42
|
| Rate for Payer: Galaxy Health WC |
$37.01
|
| Rate for Payer: Global Benefits Group Commercial |
$26.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.48
|
| Rate for Payer: Multiplan Commercial |
$34.83
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$37.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.77
|
| Rate for Payer: United Healthcare All Other HMO |
$21.77
|
| Rate for Payer: United Healthcare HMO Rider |
$21.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.01
|
| Rate for Payer: Vantage Medical Group Senior |
$37.01
|
|
|
HC DRSNG OPTIFOAM HRTMATE
|
Facility
|
IP
|
$10.09
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$8.58 |
| Rate for Payer: Adventist Health Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$8.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$8.07
|
| Rate for Payer: Networks By Design Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.58
|
|
|
HC DRSNG OPTIFOAM HRTMATE
|
Facility
|
OP
|
$10.09
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$27.67 |
| Rate for Payer: Adventist Health Commercial |
$2.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.47
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cigna of CA HMO |
$6.46
|
| Rate for Payer: Cigna of CA PPO |
$7.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$8.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.06
|
| Rate for Payer: Multiplan Commercial |
$8.07
|
| Rate for Payer: Networks By Design Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.58
|
| Rate for Payer: Vantage Medical Group Senior |
$8.58
|
|
|
HC DRSNG OPTIFOAM SACRUM 7X7"
|
Facility
|
IP
|
$52.15
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$44.33 |
| Rate for Payer: Adventist Health Commercial |
$10.43
|
| Rate for Payer: Cash Price |
$23.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.86
|
| Rate for Payer: EPIC Health Plan Senior |
$20.86
|
| Rate for Payer: Galaxy Health WC |
$44.33
|
| Rate for Payer: Global Benefits Group Commercial |
$31.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.52
|
| Rate for Payer: Multiplan Commercial |
$41.72
|
| Rate for Payer: Networks By Design Commercial |
$33.90
|
| Rate for Payer: Prime Health Services Commercial |
$44.33
|
|
|
HC DRSNG OPTIFOAM SACRUM 7X7"
|
Facility
|
OP
|
$52.15
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$45.81 |
| Rate for Payer: Cigna of CA PPO |
$38.59
|
| Rate for Payer: Adventist Health Commercial |
$10.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.46
|
| Rate for Payer: Cash Price |
$23.47
|
| Rate for Payer: Cash Price |
$23.47
|
| Rate for Payer: Cigna of CA HMO |
$33.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.86
|
| Rate for Payer: EPIC Health Plan Senior |
$20.86
|
| Rate for Payer: Galaxy Health WC |
$44.33
|
| Rate for Payer: Global Benefits Group Commercial |
$31.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.51
|
| Rate for Payer: Multiplan Commercial |
$41.72
|
| Rate for Payer: Networks By Design Commercial |
$33.90
|
| Rate for Payer: Prime Health Services Commercial |
$44.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.07
|
| Rate for Payer: United Healthcare All Other HMO |
$26.07
|
| Rate for Payer: United Healthcare HMO Rider |
$26.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.33
|
| Rate for Payer: Vantage Medical Group Senior |
$44.33
|
|
|
HC DRSNG OPTIFOAM SACRUM 9X9"
|
Facility
|
IP
|
$81.92
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$69.63 |
| Rate for Payer: Adventist Health Commercial |
$16.38
|
| Rate for Payer: Cash Price |
$36.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.77
|
| Rate for Payer: EPIC Health Plan Senior |
$32.77
|
| Rate for Payer: Galaxy Health WC |
$69.63
|
| Rate for Payer: Global Benefits Group Commercial |
$49.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.66
|
| Rate for Payer: Multiplan Commercial |
$65.54
|
| Rate for Payer: Networks By Design Commercial |
$53.25
|
| Rate for Payer: Prime Health Services Commercial |
$69.63
|
|
|
HC DRSNG OPTIFOAM SACRUM 9X9"
|
Facility
|
OP
|
$81.92
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$69.63 |
| Rate for Payer: Adventist Health Commercial |
$16.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.57
|
| Rate for Payer: Cash Price |
$36.86
|
| Rate for Payer: Cash Price |
$36.86
|
| Rate for Payer: Cigna of CA HMO |
$52.43
|
| Rate for Payer: Cigna of CA PPO |
$60.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.77
|
| Rate for Payer: EPIC Health Plan Senior |
$32.77
|
| Rate for Payer: Galaxy Health WC |
$69.63
|
| Rate for Payer: Global Benefits Group Commercial |
$49.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.34
|
| Rate for Payer: Multiplan Commercial |
$65.54
|
| Rate for Payer: Networks By Design Commercial |
$53.25
|
| Rate for Payer: Prime Health Services Commercial |
$69.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.96
|
| Rate for Payer: United Healthcare All Other HMO |
$40.96
|
| Rate for Payer: United Healthcare HMO Rider |
$40.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.63
|
| Rate for Payer: Vantage Medical Group Senior |
$69.63
|
|
|
HC DRSNG OVAL #8, 4.0X5.7" SLCN
|
Facility
|
OP
|
$60.35
|
|
| Hospital Charge Code |
901698351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$12.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.73
|
| Rate for Payer: Cash Price |
$27.16
|
| Rate for Payer: Cigna of CA HMO |
$38.62
|
| Rate for Payer: Cigna of CA PPO |
$44.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.14
|
| Rate for Payer: EPIC Health Plan Senior |
$24.14
|
| Rate for Payer: Galaxy Health WC |
$51.30
|
| Rate for Payer: Global Benefits Group Commercial |
$36.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.24
|
| Rate for Payer: Multiplan Commercial |
$48.28
|
| Rate for Payer: Networks By Design Commercial |
$39.23
|
| Rate for Payer: Prime Health Services Commercial |
$51.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.18
|
| Rate for Payer: United Healthcare All Other HMO |
$30.18
|
| Rate for Payer: United Healthcare HMO Rider |
$30.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.30
|
| Rate for Payer: Vantage Medical Group Senior |
$51.30
|
|
|
HC DRSNG OVAL #8, 4.0X5.7" SLCN
|
Facility
|
IP
|
$60.35
|
|
| Hospital Charge Code |
901698351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$12.07
|
| Rate for Payer: Cash Price |
$27.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.14
|
| Rate for Payer: EPIC Health Plan Senior |
$24.14
|
| Rate for Payer: Galaxy Health WC |
$51.30
|
| Rate for Payer: Global Benefits Group Commercial |
$36.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.48
|
| Rate for Payer: Multiplan Commercial |
$48.28
|
| Rate for Payer: Networks By Design Commercial |
$39.23
|
| Rate for Payer: Prime Health Services Commercial |
$51.30
|
|
|
HC DRSNG PACKING STRIPS 1/4"IODO
|
Facility
|
OP
|
$19.43
|
|
| Hospital Charge Code |
901600274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.47
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cigna of CA HMO |
$12.44
|
| Rate for Payer: Cigna of CA PPO |
$14.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Senior |
$7.77
|
| Rate for Payer: Galaxy Health WC |
$16.52
|
| Rate for Payer: Global Benefits Group Commercial |
$11.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$15.54
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$16.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.71
|
| Rate for Payer: United Healthcare All Other HMO |
$9.71
|
| Rate for Payer: United Healthcare HMO Rider |
$9.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.52
|
| Rate for Payer: Vantage Medical Group Senior |
$16.52
|
|
|
HC DRSNG PACKING STRIPS 1/4"IODO
|
Facility
|
IP
|
$19.43
|
|
| Hospital Charge Code |
901600274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.77
|
| Rate for Payer: EPIC Health Plan Senior |
$7.77
|
| Rate for Payer: Galaxy Health WC |
$16.52
|
| Rate for Payer: Global Benefits Group Commercial |
$11.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$15.54
|
| Rate for Payer: Networks By Design Commercial |
$12.63
|
| Rate for Payer: Prime Health Services Commercial |
$16.52
|
|
|
HC DRSNG PACKING STRIPS 1" PLAIN
|
Facility
|
OP
|
$14.43
|
|
| Hospital Charge Code |
901600272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.27 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.26
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$10.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.77
|
| Rate for Payer: EPIC Health Plan Senior |
$5.77
|
| Rate for Payer: Galaxy Health WC |
$12.27
|
| Rate for Payer: Global Benefits Group Commercial |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.10
|
| Rate for Payer: Multiplan Commercial |
$11.54
|
| Rate for Payer: Networks By Design Commercial |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$12.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other HMO |
$7.21
|
| Rate for Payer: United Healthcare HMO Rider |
$7.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.27
|
| Rate for Payer: Vantage Medical Group Senior |
$12.27
|
|
|
HC DRSNG PACKING STRIPS 1" PLAIN
|
Facility
|
IP
|
$14.43
|
|
| Hospital Charge Code |
901600272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.27 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.77
|
| Rate for Payer: EPIC Health Plan Senior |
$5.77
|
| Rate for Payer: Galaxy Health WC |
$12.27
|
| Rate for Payer: Global Benefits Group Commercial |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$11.54
|
| Rate for Payer: Networks By Design Commercial |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$12.27
|
|
|
HC DRSNG PACKING STRIPS 2"
|
Facility
|
OP
|
$32.72
|
|
| Hospital Charge Code |
901600278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$27.81 |
| Rate for Payer: Adventist Health Commercial |
$6.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.00
|
| Rate for Payer: Cash Price |
$14.72
|
| Rate for Payer: Cigna of CA HMO |
$20.94
|
| Rate for Payer: Cigna of CA PPO |
$24.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.09
|
| Rate for Payer: EPIC Health Plan Senior |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$27.81
|
| Rate for Payer: Global Benefits Group Commercial |
$19.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.90
|
| Rate for Payer: Multiplan Commercial |
$26.18
|
| Rate for Payer: Networks By Design Commercial |
$21.27
|
| Rate for Payer: Prime Health Services Commercial |
$27.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.36
|
| Rate for Payer: United Healthcare All Other HMO |
$16.36
|
| Rate for Payer: United Healthcare HMO Rider |
$16.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.81
|
| Rate for Payer: Vantage Medical Group Senior |
$27.81
|
|
|
HC DRSNG PACKING STRIPS 2"
|
Facility
|
IP
|
$32.72
|
|
| Hospital Charge Code |
901600278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$27.81 |
| Rate for Payer: Adventist Health Commercial |
$6.54
|
| Rate for Payer: Cash Price |
$14.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.09
|
| Rate for Payer: EPIC Health Plan Senior |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$27.81
|
| Rate for Payer: Global Benefits Group Commercial |
$19.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.85
|
| Rate for Payer: Multiplan Commercial |
$26.18
|
| Rate for Payer: Networks By Design Commercial |
$21.27
|
| Rate for Payer: Prime Health Services Commercial |
$27.81
|
|
