|
HC DRSNG POLYM OVAL #5, 3X2" SLCN
|
Facility
|
OP
|
$24.11
|
|
| Hospital Charge Code |
901698350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$20.49 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.47
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: Cigna of CA HMO |
$15.43
|
| Rate for Payer: Cigna of CA PPO |
$17.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.64
|
| Rate for Payer: EPIC Health Plan Senior |
$9.64
|
| Rate for Payer: Galaxy Health WC |
$20.49
|
| Rate for Payer: Global Benefits Group Commercial |
$14.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.88
|
| Rate for Payer: Multiplan Commercial |
$19.29
|
| Rate for Payer: Networks By Design Commercial |
$15.67
|
| Rate for Payer: Prime Health Services Commercial |
$20.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO |
$12.05
|
| Rate for Payer: United Healthcare HMO Rider |
$12.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.49
|
| Rate for Payer: Vantage Medical Group Senior |
$20.49
|
|
|
HC DRSNG PRIMAPORE 13.75" X 4"
|
Facility
|
IP
|
$14.02
|
|
| Hospital Charge Code |
901698920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.92 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$11.92
|
| Rate for Payer: Global Benefits Group Commercial |
$8.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$11.22
|
| Rate for Payer: Networks By Design Commercial |
$9.11
|
| Rate for Payer: Prime Health Services Commercial |
$11.92
|
|
|
HC DRSNG PRIMAPORE 13.75" X 4"
|
Facility
|
OP
|
$14.02
|
|
| Hospital Charge Code |
901698920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.92 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.00
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cigna of CA HMO |
$8.97
|
| Rate for Payer: Cigna of CA PPO |
$10.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$11.92
|
| Rate for Payer: Global Benefits Group Commercial |
$8.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.81
|
| Rate for Payer: Multiplan Commercial |
$11.22
|
| Rate for Payer: Networks By Design Commercial |
$9.11
|
| Rate for Payer: Prime Health Services Commercial |
$11.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.92
|
| Rate for Payer: Vantage Medical Group Senior |
$11.92
|
|
|
HC DRSNG PRIMAPORE 6X3 1/8" ADHSV
|
Facility
|
OP
|
$4.02
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901698885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.58
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cigna of CA HMO |
$2.57
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$3.22
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2.01
|
| Rate for Payer: United Healthcare HMO Rider |
$2.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: Vantage Medical Group Senior |
$3.42
|
|
|
HC DRSNG PRIMAPORE 6X3 1/8" ADHSV
|
Facility
|
IP
|
$4.02
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901698885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$3.22
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.42
|
|
|
HC DRSNG PRIMAPORE 8 X 4"
|
Facility
|
IP
|
$6.72
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901604508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$5.38
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Prime Health Services Commercial |
$5.71
|
|
|
HC DRSNG PRIMAPORE 8 X 4"
|
Facility
|
OP
|
$6.72
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901604508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.31
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cigna of CA HMO |
$4.30
|
| Rate for Payer: Cigna of CA PPO |
$4.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$5.38
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Prime Health Services Commercial |
$5.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.71
|
| Rate for Payer: Vantage Medical Group Senior |
$5.71
|
|
|
HC DRSNG QUICKCLOT HEMO 4X4"
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
901698425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.54
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC DRSNG QUICKCLOT HEMO 4X4"
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
901698425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC DRSNG QUICKCLOT Z-FOLD
|
Facility
|
IP
|
$304.92
|
|
| Hospital Charge Code |
901608008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$259.18 |
| Rate for Payer: Adventist Health Commercial |
$60.98
|
| Rate for Payer: Cash Price |
$137.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$213.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.97
|
| Rate for Payer: EPIC Health Plan Senior |
$121.97
|
| Rate for Payer: Galaxy Health WC |
$259.18
|
| Rate for Payer: Global Benefits Group Commercial |
$182.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$193.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.18
|
| Rate for Payer: Multiplan Commercial |
$243.94
|
| Rate for Payer: Networks By Design Commercial |
$198.20
|
| Rate for Payer: Prime Health Services Commercial |
$259.18
|
|
|
HC DRSNG QUICKCLOT Z-FOLD
|
Facility
|
OP
|
$304.92
|
|
| Hospital Charge Code |
901608008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$259.18 |
| Rate for Payer: Adventist Health Commercial |
$60.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$200.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.67
|
| Rate for Payer: Cash Price |
$137.21
|
| Rate for Payer: Cigna of CA HMO |
$195.15
|
| Rate for Payer: Cigna of CA PPO |
$225.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$213.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.97
|
| Rate for Payer: EPIC Health Plan Senior |
$121.97
|
| Rate for Payer: Galaxy Health WC |
$259.18
|
| Rate for Payer: Global Benefits Group Commercial |
$182.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$193.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.44
|
| Rate for Payer: Multiplan Commercial |
$243.94
|
| Rate for Payer: Networks By Design Commercial |
$198.20
|
| Rate for Payer: Prime Health Services Commercial |
$259.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.46
|
| Rate for Payer: United Healthcare All Other HMO |
$152.46
|
| Rate for Payer: United Healthcare HMO Rider |
$152.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.18
|
| Rate for Payer: Vantage Medical Group Senior |
$259.18
|
|
|
HC DRSNG RENASYS ABD KIT
|
Facility
|
IP
|
$224.70
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Adventist Health Commercial |
$44.94
|
| Rate for Payer: Cash Price |
$101.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.88
|
| Rate for Payer: EPIC Health Plan Senior |
$89.88
|
| Rate for Payer: Galaxy Health WC |
$191.00
|
| Rate for Payer: Global Benefits Group Commercial |
$134.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.93
|
| Rate for Payer: Multiplan Commercial |
$179.76
|
| Rate for Payer: Networks By Design Commercial |
$146.06
|
| Rate for Payer: Prime Health Services Commercial |
$191.00
|
|
|
HC DRSNG RENASYS ABD KIT
|
Facility
|
OP
|
$224.70
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$191.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Adventist Health Commercial |
$44.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.19
|
| Rate for Payer: Cash Price |
$101.12
|
| Rate for Payer: Cash Price |
$101.12
|
| Rate for Payer: Cigna of CA HMO |
$143.81
|
| Rate for Payer: Cigna of CA PPO |
$166.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.88
|
| Rate for Payer: EPIC Health Plan Senior |
$89.88
|
| Rate for Payer: Galaxy Health WC |
$191.00
|
| Rate for Payer: Global Benefits Group Commercial |
$134.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.29
|
| Rate for Payer: Multiplan Commercial |
$179.76
|
| Rate for Payer: Networks By Design Commercial |
$146.06
|
| Rate for Payer: Prime Health Services Commercial |
$191.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.35
|
| Rate for Payer: United Healthcare All Other HMO |
$112.35
|
| Rate for Payer: United Healthcare HMO Rider |
$112.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.00
|
| Rate for Payer: Vantage Medical Group Senior |
$191.00
|
|
|
HC DRSNG RENASYS F-FOAM LG KIT
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC DRSNG RENASYS F-FOAM LG KIT
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC DRSNG RENSASYS F-FOAM SM KIT
|
Facility
|
IP
|
$47.48
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$40.36 |
| Rate for Payer: Adventist Health Commercial |
$9.50
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: EPIC Health Plan Senior |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Multiplan Commercial |
$37.98
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
|
|
HC DRSNG RENSASYS F-FOAM SM KIT
|
Facility
|
OP
|
$47.48
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: Adventist Health Commercial |
$9.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.47
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Cigna of CA HMO |
$30.39
|
| Rate for Payer: Cigna of CA PPO |
$35.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: EPIC Health Plan Senior |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.24
|
| Rate for Payer: Multiplan Commercial |
$37.98
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.74
|
| Rate for Payer: United Healthcare All Other HMO |
$23.74
|
| Rate for Payer: United Healthcare HMO Rider |
$23.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.36
|
| Rate for Payer: Vantage Medical Group Senior |
$40.36
|
|
|
HC DRSNG SHEET 2X2 HD THERAHONEY
|
Facility
|
OP
|
$29.19
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901698902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$24.81 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.73
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cigna of CA HMO |
$18.68
|
| Rate for Payer: Cigna of CA PPO |
$21.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11.68
|
| Rate for Payer: Galaxy Health WC |
$24.81
|
| Rate for Payer: Global Benefits Group Commercial |
$17.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.43
|
| Rate for Payer: Multiplan Commercial |
$23.35
|
| Rate for Payer: Networks By Design Commercial |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$24.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.60
|
| Rate for Payer: United Healthcare All Other HMO |
$14.60
|
| Rate for Payer: United Healthcare HMO Rider |
$14.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.81
|
|
|
HC DRSNG SHEET 2X2 HD THERAHONEY
|
Facility
|
IP
|
$29.19
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901698902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$24.81 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11.68
|
| Rate for Payer: Galaxy Health WC |
$24.81
|
| Rate for Payer: Global Benefits Group Commercial |
$17.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$23.35
|
| Rate for Payer: Networks By Design Commercial |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$24.81
|
|
|
HC DRSNG SHEET 4X5 HD THERAHONEY
|
Facility
|
OP
|
$66.34
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$56.39 |
| Rate for Payer: Adventist Health Commercial |
$13.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.57
|
| Rate for Payer: Cash Price |
$29.85
|
| Rate for Payer: Cash Price |
$29.85
|
| Rate for Payer: Cigna of CA HMO |
$42.46
|
| Rate for Payer: Cigna of CA PPO |
$49.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.54
|
| Rate for Payer: EPIC Health Plan Senior |
$26.54
|
| Rate for Payer: Galaxy Health WC |
$56.39
|
| Rate for Payer: Global Benefits Group Commercial |
$39.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.44
|
| Rate for Payer: Multiplan Commercial |
$53.07
|
| Rate for Payer: Networks By Design Commercial |
$43.12
|
| Rate for Payer: Prime Health Services Commercial |
$56.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.17
|
| Rate for Payer: United Healthcare All Other HMO |
$33.17
|
| Rate for Payer: United Healthcare HMO Rider |
$33.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.39
|
| Rate for Payer: Vantage Medical Group Senior |
$56.39
|
|
|
HC DRSNG SHEET 4X5 HD THERAHONEY
|
Facility
|
IP
|
$66.34
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$56.39 |
| Rate for Payer: Adventist Health Commercial |
$13.27
|
| Rate for Payer: Cash Price |
$29.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.54
|
| Rate for Payer: EPIC Health Plan Senior |
$26.54
|
| Rate for Payer: Galaxy Health WC |
$56.39
|
| Rate for Payer: Global Benefits Group Commercial |
$39.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.92
|
| Rate for Payer: Multiplan Commercial |
$53.07
|
| Rate for Payer: Networks By Design Commercial |
$43.12
|
| Rate for Payer: Prime Health Services Commercial |
$56.39
|
|
|
HC DRSNG SHEET 4X5 THERAHONEY
|
Facility
|
OP
|
$48.79
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Adventist Health Commercial |
$9.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.31
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Cigna of CA HMO |
$31.23
|
| Rate for Payer: Cigna of CA PPO |
$36.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.52
|
| Rate for Payer: EPIC Health Plan Senior |
$19.52
|
| Rate for Payer: Galaxy Health WC |
$41.47
|
| Rate for Payer: Global Benefits Group Commercial |
$29.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.15
|
| Rate for Payer: Multiplan Commercial |
$39.03
|
| Rate for Payer: Networks By Design Commercial |
$31.71
|
| Rate for Payer: Prime Health Services Commercial |
$41.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.39
|
| Rate for Payer: United Healthcare All Other HMO |
$24.39
|
| Rate for Payer: United Healthcare HMO Rider |
$24.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.47
|
| Rate for Payer: Vantage Medical Group Senior |
$41.47
|
|
|
HC DRSNG SHEET 4X5 THERAHONEY
|
Facility
|
IP
|
$48.79
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Adventist Health Commercial |
$9.76
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.52
|
| Rate for Payer: EPIC Health Plan Senior |
$19.52
|
| Rate for Payer: Galaxy Health WC |
$41.47
|
| Rate for Payer: Global Benefits Group Commercial |
$29.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.71
|
| Rate for Payer: Multiplan Commercial |
$39.03
|
| Rate for Payer: Networks By Design Commercial |
$31.71
|
| Rate for Payer: Prime Health Services Commercial |
$41.47
|
|
|
HC DRSNG SILVASORB SITE 1.75 HRTM
|
Facility
|
OP
|
$50.59
|
|
| Hospital Charge Code |
901692017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Adventist Health Commercial |
$10.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.46
|
| Rate for Payer: Cash Price |
$22.77
|
| Rate for Payer: Cigna of CA HMO |
$32.38
|
| Rate for Payer: Cigna of CA PPO |
$37.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$43.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.41
|
| Rate for Payer: Multiplan Commercial |
$40.47
|
| Rate for Payer: Networks By Design Commercial |
$32.88
|
| Rate for Payer: Prime Health Services Commercial |
$43.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.30
|
| Rate for Payer: United Healthcare All Other HMO |
$25.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.00
|
| Rate for Payer: Vantage Medical Group Senior |
$43.00
|
|
|
HC DRSNG SILVASORB SITE 1.75 HRTM
|
Facility
|
IP
|
$50.59
|
|
| Hospital Charge Code |
901692017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Adventist Health Commercial |
$10.12
|
| Rate for Payer: Cash Price |
$22.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$43.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.14
|
| Rate for Payer: Multiplan Commercial |
$40.47
|
| Rate for Payer: Networks By Design Commercial |
$32.88
|
| Rate for Payer: Prime Health Services Commercial |
$43.00
|
|
