|
HC DRSNG TRANSPARENT 4 X 4 3/4
|
Facility
|
OP
|
$1.23
|
|
| Hospital Charge Code |
901605327
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Adventist Health Commercial |
$0.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.79
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: Cigna of CA HMO |
$0.79
|
| Rate for Payer: Cigna of CA PPO |
$0.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.49
|
| Rate for Payer: EPIC Health Plan Senior |
$0.49
|
| Rate for Payer: Galaxy Health WC |
$1.05
|
| Rate for Payer: Global Benefits Group Commercial |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.80
|
| Rate for Payer: Prime Health Services Commercial |
$1.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.62
|
| Rate for Payer: United Healthcare All Other HMO |
$0.62
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1.05
|
|
|
HC DRSNG TRANSPARENT FILM
|
Facility
|
IP
|
$76.10
|
|
| Hospital Charge Code |
901698188
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Cash Price |
$34.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.69
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.26
|
| Rate for Payer: Multiplan Commercial |
$60.88
|
| Rate for Payer: Networks By Design Commercial |
$49.47
|
| Rate for Payer: Prime Health Services Commercial |
$64.69
|
|
|
HC DRSNG TRANSPARENT FILM
|
Facility
|
OP
|
$76.10
|
|
| Hospital Charge Code |
901698188
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.83
|
| Rate for Payer: Cash Price |
$34.24
|
| Rate for Payer: Cigna of CA HMO |
$48.70
|
| Rate for Payer: Cigna of CA PPO |
$56.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.69
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.27
|
| Rate for Payer: Multiplan Commercial |
$60.88
|
| Rate for Payer: Networks By Design Commercial |
$49.47
|
| Rate for Payer: Prime Health Services Commercial |
$64.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.69
|
| Rate for Payer: Vantage Medical Group Senior |
$64.69
|
|
|
HC DRSNG TRANSPARENT FILM 4X4IN
|
Facility
|
OP
|
$316.82
|
|
| Hospital Charge Code |
901698577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$269.30 |
| Rate for Payer: Adventist Health Commercial |
$63.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$269.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$174.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.30
|
| Rate for Payer: Cash Price |
$142.57
|
| Rate for Payer: Cigna of CA HMO |
$202.76
|
| Rate for Payer: Cigna of CA PPO |
$234.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$269.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$269.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$269.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$221.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.73
|
| Rate for Payer: EPIC Health Plan Senior |
$126.73
|
| Rate for Payer: Galaxy Health WC |
$269.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$186.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.77
|
| Rate for Payer: Multiplan Commercial |
$253.46
|
| Rate for Payer: Networks By Design Commercial |
$205.93
|
| Rate for Payer: Prime Health Services Commercial |
$269.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.41
|
| Rate for Payer: United Healthcare All Other HMO |
$158.41
|
| Rate for Payer: United Healthcare HMO Rider |
$158.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$269.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$269.30
|
| Rate for Payer: Vantage Medical Group Senior |
$269.30
|
|
|
HC DRSNG TRANSPARENT FILM 4X4IN
|
Facility
|
IP
|
$316.82
|
|
| Hospital Charge Code |
901698577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$269.30 |
| Rate for Payer: Adventist Health Commercial |
$63.36
|
| Rate for Payer: Cash Price |
$142.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$221.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.73
|
| Rate for Payer: EPIC Health Plan Senior |
$126.73
|
| Rate for Payer: Galaxy Health WC |
$269.30
|
| Rate for Payer: Global Benefits Group Commercial |
$190.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$186.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.04
|
| Rate for Payer: Multiplan Commercial |
$253.46
|
| Rate for Payer: Networks By Design Commercial |
$205.93
|
| Rate for Payer: Prime Health Services Commercial |
$269.30
|
|
|
HC DRSNG TRANSPARENT IV3000 4"X5"
|
Facility
|
OP
|
$7.95
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901607678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$12.31 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.10
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$6.36
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC DRSNG TRANSPARENT IV3000 4"X5"
|
Facility
|
IP
|
$7.95
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901607678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$6.36
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
|
HC DRSNG TRANSPARENT IV3000 4X8IN
|
Facility
|
OP
|
$14.19
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901607688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.31 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.11
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Cigna of CA HMO |
$9.08
|
| Rate for Payer: Cigna of CA PPO |
$10.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.93
|
| Rate for Payer: Multiplan Commercial |
$11.35
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.09
|
| Rate for Payer: United Healthcare All Other HMO |
$7.09
|
| Rate for Payer: United Healthcare HMO Rider |
$7.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.06
|
| Rate for Payer: Vantage Medical Group Senior |
$12.06
|
|
|
HC DRSNG TRANSPARENT IV3000 4X8IN
|
Facility
|
IP
|
$14.19
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901607688
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$12.06 |
| Rate for Payer: Adventist Health Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.68
|
| Rate for Payer: EPIC Health Plan Senior |
$5.68
|
| Rate for Payer: Galaxy Health WC |
$12.06
|
| Rate for Payer: Global Benefits Group Commercial |
$8.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.41
|
| Rate for Payer: Multiplan Commercial |
$11.35
|
| Rate for Payer: Networks By Design Commercial |
$9.22
|
| Rate for Payer: Prime Health Services Commercial |
$12.06
|
|
|
HC DRSNG TRANSPARENT IV 3.5"X4.5"
|
Facility
|
OP
|
$8.12
|
|
| Hospital Charge Code |
901698830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.90 |
| Rate for Payer: Adventist Health Commercial |
$1.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.21
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cigna of CA HMO |
$5.20
|
| Rate for Payer: Cigna of CA PPO |
$6.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.25
|
| Rate for Payer: EPIC Health Plan Senior |
$3.25
|
| Rate for Payer: Galaxy Health WC |
$6.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.68
|
| Rate for Payer: Multiplan Commercial |
$6.50
|
| Rate for Payer: Networks By Design Commercial |
$5.28
|
| Rate for Payer: Prime Health Services Commercial |
$6.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.06
|
| Rate for Payer: United Healthcare All Other HMO |
$4.06
|
| Rate for Payer: United Healthcare HMO Rider |
$4.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6.90
|
|
|
HC DRSNG TRANSPARENT IV 3.5"X4.5"
|
Facility
|
IP
|
$8.12
|
|
| Hospital Charge Code |
901698830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$6.90 |
| Rate for Payer: Adventist Health Commercial |
$1.62
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.25
|
| Rate for Payer: EPIC Health Plan Senior |
$3.25
|
| Rate for Payer: Galaxy Health WC |
$6.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$6.50
|
| Rate for Payer: Networks By Design Commercial |
$5.28
|
| Rate for Payer: Prime Health Services Commercial |
$6.90
|
|
|
HC DRSNG TRANSPRNT HYDRO 4X4 PLUS
|
Facility
|
IP
|
$29.68
|
|
| Hospital Charge Code |
901698752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Adventist Health Commercial |
$5.94
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.87
|
| Rate for Payer: EPIC Health Plan Senior |
$11.87
|
| Rate for Payer: Galaxy Health WC |
$25.23
|
| Rate for Payer: Global Benefits Group Commercial |
$17.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.12
|
| Rate for Payer: Multiplan Commercial |
$23.74
|
| Rate for Payer: Networks By Design Commercial |
$19.29
|
| Rate for Payer: Prime Health Services Commercial |
$25.23
|
|
|
HC DRSNG TRANSPRNT HYDRO 4X4 PLUS
|
Facility
|
OP
|
$29.68
|
|
| Hospital Charge Code |
901698752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Adventist Health Commercial |
$5.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.05
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cigna of CA HMO |
$19.00
|
| Rate for Payer: Cigna of CA PPO |
$21.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.87
|
| Rate for Payer: EPIC Health Plan Senior |
$11.87
|
| Rate for Payer: Galaxy Health WC |
$25.23
|
| Rate for Payer: Global Benefits Group Commercial |
$17.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.78
|
| Rate for Payer: Multiplan Commercial |
$23.74
|
| Rate for Payer: Networks By Design Commercial |
$19.29
|
| Rate for Payer: Prime Health Services Commercial |
$25.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.84
|
| Rate for Payer: United Healthcare All Other HMO |
$14.84
|
| Rate for Payer: United Healthcare HMO Rider |
$14.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$25.23
|
|
|
HC DRSNG TRANSPRNT HYDRO 4X4 THIN
|
Facility
|
OP
|
$25.91
|
|
| Hospital Charge Code |
901698751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.63
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cigna of CA HMO |
$16.58
|
| Rate for Payer: Cigna of CA PPO |
$19.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: EPIC Health Plan Senior |
$10.36
|
| Rate for Payer: Galaxy Health WC |
$22.02
|
| Rate for Payer: Global Benefits Group Commercial |
$15.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$20.73
|
| Rate for Payer: Networks By Design Commercial |
$16.84
|
| Rate for Payer: Prime Health Services Commercial |
$22.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.96
|
| Rate for Payer: United Healthcare All Other HMO |
$12.96
|
| Rate for Payer: United Healthcare HMO Rider |
$12.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.02
|
| Rate for Payer: Vantage Medical Group Senior |
$22.02
|
|
|
HC DRSNG TRANSPRNT HYDRO 4X4 THIN
|
Facility
|
IP
|
$25.91
|
|
| Hospital Charge Code |
901698751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$5.18
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: EPIC Health Plan Senior |
$10.36
|
| Rate for Payer: Galaxy Health WC |
$22.02
|
| Rate for Payer: Global Benefits Group Commercial |
$15.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.22
|
| Rate for Payer: Multiplan Commercial |
$20.73
|
| Rate for Payer: Networks By Design Commercial |
$16.84
|
| Rate for Payer: Prime Health Services Commercial |
$22.02
|
|
|
HC DRSNG TRNSPRNT 2.75X3.2 HRMT
|
Facility
|
OP
|
$3.60
|
|
| Hospital Charge Code |
901692016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.31
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
HC DRSNG TRNSPRNT 2.75X3.2 HRMT
|
Facility
|
IP
|
$3.60
|
|
| Hospital Charge Code |
901692016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$2.88
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
HC DRSNG VAC ACTICOAT FLEX 3 4X4
|
Facility
|
IP
|
$102.60
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: EPIC Health Plan Senior |
$41.04
|
| Rate for Payer: Galaxy Health WC |
$87.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.04
|
| Rate for Payer: Adventist Health Commercial |
$20.52
|
| Rate for Payer: Cash Price |
$46.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.82
|
| Rate for Payer: Global Benefits Group Commercial |
$61.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.62
|
| Rate for Payer: Multiplan Commercial |
$82.08
|
| Rate for Payer: Networks By Design Commercial |
$66.69
|
| Rate for Payer: Prime Health Services Commercial |
$87.21
|
|
|
HC DRSNG VAC ACTICOAT FLEX 3 4X4
|
Facility
|
OP
|
$102.60
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Adventist Health Commercial |
$20.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.84
|
| Rate for Payer: Cash Price |
$46.17
|
| Rate for Payer: Cash Price |
$46.17
|
| Rate for Payer: Cigna of CA HMO |
$65.66
|
| Rate for Payer: Cigna of CA PPO |
$75.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.04
|
| Rate for Payer: EPIC Health Plan Senior |
$41.04
|
| Rate for Payer: Galaxy Health WC |
$87.21
|
| Rate for Payer: Global Benefits Group Commercial |
$61.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.82
|
| Rate for Payer: Multiplan Commercial |
$82.08
|
| Rate for Payer: Networks By Design Commercial |
$66.69
|
| Rate for Payer: Prime Health Services Commercial |
$87.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.30
|
| Rate for Payer: United Healthcare All Other HMO |
$51.30
|
| Rate for Payer: United Healthcare HMO Rider |
$51.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.21
|
| Rate for Payer: Vantage Medical Group Senior |
$87.21
|
|
|
HC DRSNG VAC GAUZE ROLL LRG ANTIM
|
Facility
|
IP
|
$60.76
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$51.65 |
| Rate for Payer: Adventist Health Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Senior |
$24.30
|
| Rate for Payer: Galaxy Health WC |
$51.65
|
| Rate for Payer: Global Benefits Group Commercial |
$36.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.58
|
| Rate for Payer: Multiplan Commercial |
$48.61
|
| Rate for Payer: Networks By Design Commercial |
$39.49
|
| Rate for Payer: Prime Health Services Commercial |
$51.65
|
|
|
HC DRSNG VAC GAUZE ROLL LRG ANTIM
|
Facility
|
OP
|
$60.76
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: Adventist Health Commercial |
$12.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.99
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cigna of CA HMO |
$38.89
|
| Rate for Payer: Cigna of CA PPO |
$44.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Senior |
$24.30
|
| Rate for Payer: Galaxy Health WC |
$51.65
|
| Rate for Payer: Global Benefits Group Commercial |
$36.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.53
|
| Rate for Payer: Multiplan Commercial |
$48.61
|
| Rate for Payer: Networks By Design Commercial |
$39.49
|
| Rate for Payer: Prime Health Services Commercial |
$51.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.38
|
| Rate for Payer: United Healthcare All Other HMO |
$30.38
|
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.65
|
| Rate for Payer: Vantage Medical Group Senior |
$51.65
|
|
|
HC DRSNG VAC RESTORE AG 4X5
|
Facility
|
IP
|
$62.73
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901606110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$53.32 |
| Rate for Payer: Adventist Health Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.09
|
| Rate for Payer: EPIC Health Plan Senior |
$25.09
|
| Rate for Payer: Galaxy Health WC |
$53.32
|
| Rate for Payer: Global Benefits Group Commercial |
$37.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.06
|
| Rate for Payer: Multiplan Commercial |
$50.18
|
| Rate for Payer: Networks By Design Commercial |
$40.77
|
| Rate for Payer: Prime Health Services Commercial |
$53.32
|
|
|
HC DRSNG VAC RESTORE AG 4X5
|
Facility
|
OP
|
$62.73
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901606110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$53.32 |
| Rate for Payer: Adventist Health Commercial |
$12.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.25
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Cigna of CA HMO |
$40.15
|
| Rate for Payer: Cigna of CA PPO |
$46.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.09
|
| Rate for Payer: EPIC Health Plan Senior |
$25.09
|
| Rate for Payer: Galaxy Health WC |
$53.32
|
| Rate for Payer: Global Benefits Group Commercial |
$37.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.91
|
| Rate for Payer: Multiplan Commercial |
$50.18
|
| Rate for Payer: Networks By Design Commercial |
$40.77
|
| Rate for Payer: Prime Health Services Commercial |
$53.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.36
|
| Rate for Payer: United Healthcare All Other HMO |
$31.36
|
| Rate for Payer: United Healthcare HMO Rider |
$31.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.32
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
|
|
HC DRSNG VAC VERAFLO CLEANSE MED
|
Facility
|
IP
|
$633.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.71 |
| Max. Negotiated Rate |
$538.53 |
| Rate for Payer: Adventist Health Commercial |
$126.71
|
| Rate for Payer: Cash Price |
$285.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.42
|
| Rate for Payer: EPIC Health Plan Senior |
$253.42
|
| Rate for Payer: Galaxy Health WC |
$538.53
|
| Rate for Payer: Global Benefits Group Commercial |
$380.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.05
|
| Rate for Payer: Multiplan Commercial |
$506.85
|
| Rate for Payer: Networks By Design Commercial |
$411.81
|
| Rate for Payer: Prime Health Services Commercial |
$538.53
|
|
|
HC DRSNG VAC VERAFLO CLEANSE MED
|
Facility
|
OP
|
$633.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$538.53 |
| Rate for Payer: Adventist Health Commercial |
$126.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.56
|
| Rate for Payer: Cash Price |
$285.10
|
| Rate for Payer: Cash Price |
$285.10
|
| Rate for Payer: Cigna of CA HMO |
$405.48
|
| Rate for Payer: Cigna of CA PPO |
$468.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.42
|
| Rate for Payer: EPIC Health Plan Senior |
$253.42
|
| Rate for Payer: Galaxy Health WC |
$538.53
|
| Rate for Payer: Global Benefits Group Commercial |
$380.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$443.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$443.49
|
| Rate for Payer: Multiplan Commercial |
$506.85
|
| Rate for Payer: Networks By Design Commercial |
$411.81
|
| Rate for Payer: Prime Health Services Commercial |
$538.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.78
|
| Rate for Payer: United Healthcare All Other HMO |
$316.78
|
| Rate for Payer: United Healthcare HMO Rider |
$316.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$316.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$538.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.53
|
| Rate for Payer: Vantage Medical Group Senior |
$538.53
|
|
