|
HC DRSNG WND ADHESV RENASYS GEL P
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$35.55 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.73
|
| Rate for Payer: Galaxy Health WC |
$35.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$33.46
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.55
|
|
|
HC DRSNG WND ADHESV RENASYS GEL P
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$35.55 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.84
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cigna of CA HMO |
$26.76
|
| Rate for Payer: Cigna of CA PPO |
$30.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.73
|
| Rate for Payer: Galaxy Health WC |
$35.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.27
|
| Rate for Payer: Multiplan Commercial |
$33.46
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.55
|
| Rate for Payer: Vantage Medical Group Senior |
$35.55
|
|
|
HC DRSNG WOUND 3.6 X 8" MEDPORE
|
Facility
|
OP
|
$7.79
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901698618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.00
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cigna of CA HMO |
$4.99
|
| Rate for Payer: Cigna of CA PPO |
$5.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.45
|
| Rate for Payer: Multiplan Commercial |
$6.23
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.62
|
| Rate for Payer: Vantage Medical Group Senior |
$6.62
|
|
|
HC DRSNG WOUND 3.6 X 8" MEDPORE
|
Facility
|
IP
|
$7.79
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901698618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$6.23
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
|
|
HC DRSNG WOUND ANASEPT GEL 3OZ
|
Facility
|
IP
|
$182.21
|
|
| Hospital Charge Code |
901698215
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.44 |
| Max. Negotiated Rate |
$154.88 |
| Rate for Payer: Adventist Health Commercial |
$36.44
|
| Rate for Payer: Cash Price |
$81.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.88
|
| Rate for Payer: EPIC Health Plan Senior |
$72.88
|
| Rate for Payer: Galaxy Health WC |
$154.88
|
| Rate for Payer: Global Benefits Group Commercial |
$109.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.73
|
| Rate for Payer: Multiplan Commercial |
$145.77
|
| Rate for Payer: Networks By Design Commercial |
$118.44
|
| Rate for Payer: Prime Health Services Commercial |
$154.88
|
|
|
HC DRSNG WOUND ANASEPT GEL 3OZ
|
Facility
|
OP
|
$182.21
|
|
| Hospital Charge Code |
901698215
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.44 |
| Max. Negotiated Rate |
$154.88 |
| Rate for Payer: Adventist Health Commercial |
$36.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.92
|
| Rate for Payer: Cash Price |
$81.99
|
| Rate for Payer: Cigna of CA HMO |
$116.61
|
| Rate for Payer: Cigna of CA PPO |
$134.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.88
|
| Rate for Payer: EPIC Health Plan Senior |
$72.88
|
| Rate for Payer: Galaxy Health WC |
$154.88
|
| Rate for Payer: Global Benefits Group Commercial |
$109.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.55
|
| Rate for Payer: Multiplan Commercial |
$145.77
|
| Rate for Payer: Networks By Design Commercial |
$118.44
|
| Rate for Payer: Prime Health Services Commercial |
$154.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.11
|
| Rate for Payer: United Healthcare All Other HMO |
$91.11
|
| Rate for Payer: United Healthcare HMO Rider |
$91.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.88
|
| Rate for Payer: Vantage Medical Group Senior |
$154.88
|
|
|
HC DRSNG WOUND BIOPATCH 2CM/4MM
|
Facility
|
OP
|
$54.69
|
|
| Hospital Charge Code |
901605126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$46.49 |
| Rate for Payer: Adventist Health Commercial |
$10.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.09
|
| Rate for Payer: Cash Price |
$24.61
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$40.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.88
|
| Rate for Payer: EPIC Health Plan Senior |
$21.88
|
| Rate for Payer: Galaxy Health WC |
$46.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.28
|
| Rate for Payer: Multiplan Commercial |
$43.75
|
| Rate for Payer: Networks By Design Commercial |
$35.55
|
| Rate for Payer: Prime Health Services Commercial |
$46.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.34
|
| Rate for Payer: United Healthcare All Other HMO |
$27.34
|
| Rate for Payer: United Healthcare HMO Rider |
$27.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.49
|
| Rate for Payer: Vantage Medical Group Senior |
$46.49
|
|
|
HC DRSNG WOUND BIOPATCH 2CM/4MM
|
Facility
|
IP
|
$54.69
|
|
| Hospital Charge Code |
901605126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$46.49 |
| Rate for Payer: Multiplan Commercial |
$43.75
|
| Rate for Payer: Networks By Design Commercial |
$35.55
|
| Rate for Payer: Adventist Health Commercial |
$10.94
|
| Rate for Payer: Cash Price |
$24.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.88
|
| Rate for Payer: EPIC Health Plan Senior |
$21.88
|
| Rate for Payer: Galaxy Health WC |
$46.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.13
|
| Rate for Payer: Prime Health Services Commercial |
$46.49
|
|
|
HC DRSNG WOUND DURAFIBER AG 4X4
|
Facility
|
IP
|
$61.66
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Adventist Health Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.66
|
| Rate for Payer: EPIC Health Plan Senior |
$24.66
|
| Rate for Payer: Galaxy Health WC |
$52.41
|
| Rate for Payer: Global Benefits Group Commercial |
$37.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Multiplan Commercial |
$49.33
|
| Rate for Payer: Networks By Design Commercial |
$40.08
|
| Rate for Payer: Prime Health Services Commercial |
$52.41
|
|
|
HC DRSNG WOUND DURAFIBER AG 4X4
|
Facility
|
OP
|
$61.66
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Adventist Health Commercial |
$12.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.57
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Cigna of CA HMO |
$39.46
|
| Rate for Payer: Cigna of CA PPO |
$45.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.66
|
| Rate for Payer: EPIC Health Plan Senior |
$24.66
|
| Rate for Payer: Galaxy Health WC |
$52.41
|
| Rate for Payer: Global Benefits Group Commercial |
$37.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.16
|
| Rate for Payer: Multiplan Commercial |
$49.33
|
| Rate for Payer: Networks By Design Commercial |
$40.08
|
| Rate for Payer: Prime Health Services Commercial |
$52.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.83
|
| Rate for Payer: United Healthcare All Other HMO |
$30.83
|
| Rate for Payer: United Healthcare HMO Rider |
$30.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.41
|
| Rate for Payer: Vantage Medical Group Senior |
$52.41
|
|
|
HC DRSNG WOUND ES PLUS AG RIBBON
|
Facility
|
IP
|
$74.78
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901698127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$63.56 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: Multiplan Commercial |
$59.82
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
|
|
HC DRSNG WOUND ES PLUS AG RIBBON
|
Facility
|
OP
|
$74.78
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901698127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$63.56 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.99
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Cigna of CA HMO |
$47.86
|
| Rate for Payer: Cigna of CA PPO |
$55.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.35
|
| Rate for Payer: Multiplan Commercial |
$59.82
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.39
|
| Rate for Payer: United Healthcare All Other HMO |
$37.39
|
| Rate for Payer: United Healthcare HMO Rider |
$37.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.56
|
| Rate for Payer: Vantage Medical Group Senior |
$63.56
|
|
|
HC DRSNG WOUND GAUZE ADH 4X14"
|
Facility
|
IP
|
$6.97
|
|
| Hospital Charge Code |
901698919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$5.58
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
|
|
HC DRSNG WOUND GAUZE ADH 4X14"
|
Facility
|
OP
|
$6.97
|
|
| Hospital Charge Code |
901698919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.47
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$5.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$5.58
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.92
|
| Rate for Payer: Vantage Medical Group Senior |
$5.92
|
|
|
HC DRSNG WOUND INTERDRY
|
Facility
|
OP
|
$338.45
|
|
| Hospital Charge Code |
901605294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$287.68 |
| Rate for Payer: Adventist Health Commercial |
$67.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$287.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$253.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.18
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cigna of CA HMO |
$216.61
|
| Rate for Payer: Cigna of CA PPO |
$250.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$287.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$287.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$287.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$236.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.38
|
| Rate for Payer: EPIC Health Plan Senior |
$135.38
|
| Rate for Payer: Galaxy Health WC |
$287.68
|
| Rate for Payer: Global Benefits Group Commercial |
$203.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$236.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$236.91
|
| Rate for Payer: Multiplan Commercial |
$270.76
|
| Rate for Payer: Networks By Design Commercial |
$219.99
|
| Rate for Payer: Prime Health Services Commercial |
$287.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.22
|
| Rate for Payer: United Healthcare All Other HMO |
$169.22
|
| Rate for Payer: United Healthcare HMO Rider |
$169.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$169.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$287.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$287.68
|
| Rate for Payer: Vantage Medical Group Senior |
$287.68
|
|
|
HC DRSNG WOUND INTERDRY
|
Facility
|
IP
|
$338.45
|
|
| Hospital Charge Code |
901605294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$287.68 |
| Rate for Payer: Adventist Health Commercial |
$67.69
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$236.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.38
|
| Rate for Payer: EPIC Health Plan Senior |
$135.38
|
| Rate for Payer: Galaxy Health WC |
$287.68
|
| Rate for Payer: Global Benefits Group Commercial |
$203.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.23
|
| Rate for Payer: Multiplan Commercial |
$270.76
|
| Rate for Payer: Networks By Design Commercial |
$219.99
|
| Rate for Payer: Prime Health Services Commercial |
$287.68
|
|
|
HC DRSNG WOUND MEPILEX 8X8"
|
Facility
|
IP
|
$210.84
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901695705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$179.21 |
| Rate for Payer: Adventist Health Commercial |
$42.17
|
| Rate for Payer: Cash Price |
$94.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.34
|
| Rate for Payer: EPIC Health Plan Senior |
$84.34
|
| Rate for Payer: Galaxy Health WC |
$179.21
|
| Rate for Payer: Global Benefits Group Commercial |
$126.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$168.67
|
| Rate for Payer: Networks By Design Commercial |
$137.05
|
| Rate for Payer: Prime Health Services Commercial |
$179.21
|
|
|
HC DRSNG WOUND MEPILEX 8X8"
|
Facility
|
OP
|
$210.84
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901695705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.34 |
| Max. Negotiated Rate |
$179.21 |
| Rate for Payer: United Healthcare HMO Rider |
$105.42
|
| Rate for Payer: Adventist Health Commercial |
$42.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.30
|
| Rate for Payer: Cash Price |
$94.88
|
| Rate for Payer: Cash Price |
$94.88
|
| Rate for Payer: Cigna of CA HMO |
$134.94
|
| Rate for Payer: Cigna of CA PPO |
$156.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$179.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$179.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.34
|
| Rate for Payer: EPIC Health Plan Senior |
$84.34
|
| Rate for Payer: Galaxy Health WC |
$179.21
|
| Rate for Payer: Global Benefits Group Commercial |
$126.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.59
|
| Rate for Payer: Multiplan Commercial |
$168.67
|
| Rate for Payer: Networks By Design Commercial |
$137.05
|
| Rate for Payer: Prime Health Services Commercial |
$179.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.42
|
| Rate for Payer: United Healthcare All Other HMO |
$105.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$179.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$179.21
|
| Rate for Payer: Vantage Medical Group Senior |
$179.21
|
|
|
HC DRSNG WOUND MEPORE 3.5"X6"
|
Facility
|
OP
|
$5.25
|
|
| Hospital Charge Code |
901604798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.37
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$3.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Senior |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$4.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Prime Health Services Commercial |
$4.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.46
|
| Rate for Payer: Vantage Medical Group Senior |
$4.46
|
|
|
HC DRSNG WOUND MEPORE 3.5"X6"
|
Facility
|
IP
|
$5.25
|
|
| Hospital Charge Code |
901604798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Senior |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$4.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.20
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Prime Health Services Commercial |
$4.46
|
|
|
HC DRSNG WOUND NON-ADHSV 6.125X8"
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901607859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$139.04 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.62
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRSNG WOUND NON-ADHSV 6.125X8"
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901607859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC DRSNG WOUND VAC ATS SMALL
|
Facility
|
OP
|
$225.96
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$192.07 |
| Rate for Payer: Adventist Health Commercial |
$45.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.00
|
| Rate for Payer: Cash Price |
$101.68
|
| Rate for Payer: Cash Price |
$101.68
|
| Rate for Payer: Cigna of CA HMO |
$144.61
|
| Rate for Payer: Cigna of CA PPO |
$167.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.38
|
| Rate for Payer: EPIC Health Plan Senior |
$90.38
|
| Rate for Payer: Galaxy Health WC |
$192.07
|
| Rate for Payer: Global Benefits Group Commercial |
$135.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.17
|
| Rate for Payer: Multiplan Commercial |
$180.77
|
| Rate for Payer: Networks By Design Commercial |
$146.87
|
| Rate for Payer: Prime Health Services Commercial |
$192.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.98
|
| Rate for Payer: United Healthcare All Other HMO |
$112.98
|
| Rate for Payer: United Healthcare HMO Rider |
$112.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.07
|
| Rate for Payer: Vantage Medical Group Senior |
$192.07
|
|
|
HC DRSNG WOUND VAC ATS SMALL
|
Facility
|
IP
|
$225.96
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$192.07 |
| Rate for Payer: Cash Price |
$101.68
|
| Rate for Payer: Adventist Health Commercial |
$45.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.38
|
| Rate for Payer: EPIC Health Plan Senior |
$90.38
|
| Rate for Payer: Galaxy Health WC |
$192.07
|
| Rate for Payer: Global Benefits Group Commercial |
$135.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.23
|
| Rate for Payer: Multiplan Commercial |
$180.77
|
| Rate for Payer: Networks By Design Commercial |
$146.87
|
| Rate for Payer: Prime Health Services Commercial |
$192.07
|
|
|
HC DRSNG WOUND VAC LG
|
Facility
|
IP
|
$343.77
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$292.20 |
| Rate for Payer: Adventist Health Commercial |
$68.75
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$240.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.51
|
| Rate for Payer: EPIC Health Plan Senior |
$137.51
|
| Rate for Payer: Galaxy Health WC |
$292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$206.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$218.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.50
|
| Rate for Payer: Multiplan Commercial |
$275.02
|
| Rate for Payer: Networks By Design Commercial |
$223.45
|
| Rate for Payer: Prime Health Services Commercial |
$292.20
|
|
