|
HC DRSNG ABD PAD 8X10IN STRL
|
Facility
|
IP
|
$0.90
|
|
| Hospital Charge Code |
901698913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
|
|
HC DRSNG ABSORBENT FOAM 4X4 MIPILEX
|
Facility
|
IP
|
$56.99
|
|
| Hospital Charge Code |
901696386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.29 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.44
|
| Rate for Payer: Global Benefits Group Commercial |
$34.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Multiplan Commercial |
$42.74
|
| Rate for Payer: Networks By Design Commercial |
$37.04
|
| Rate for Payer: Prime Health Services Commercial |
$48.44
|
|
|
HC DRSNG ABSORBENT FOAM 4X4 MIPILEX
|
Facility
|
OP
|
$56.99
|
|
| Hospital Charge Code |
901696386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.29 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.15
|
| Rate for Payer: Blue Shield of California Commercial |
$36.13
|
| Rate for Payer: Blue Shield of California EPN |
$22.74
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.59
|
| Rate for Payer: Cigna of CA HMO |
$36.47
|
| Rate for Payer: Cigna of CA PPO |
$42.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.44
|
| Rate for Payer: Global Benefits Group Commercial |
$34.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.89
|
| Rate for Payer: Multiplan Commercial |
$42.74
|
| Rate for Payer: Networks By Design Commercial |
$37.04
|
| Rate for Payer: Prime Health Services Commercial |
$48.44
|
| Rate for Payer: Riverside University Health System MISP |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.44
|
| Rate for Payer: Vantage Medical Group Senior |
$48.44
|
|
|
HC DRSNG ABSORBNT COMPOSITE 4X10
|
Facility
|
OP
|
$13.12
|
|
| Hospital Charge Code |
901698912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$8.32
|
| Rate for Payer: Blue Shield of California EPN |
$5.23
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Central Health Plan Commercial |
$10.50
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.18
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
| Rate for Payer: Riverside University Health System MISP |
$5.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.15
|
| Rate for Payer: Vantage Medical Group Senior |
$11.15
|
|
|
HC DRSNG ABSORBNT COMPOSITE 4X10
|
Facility
|
IP
|
$13.12
|
|
| Hospital Charge Code |
901698912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Central Health Plan Commercial |
$10.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
|
|
HC DRSNG ACTICOAT 4X10 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$210.77
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$189.69 |
| Rate for Payer: Adventist Health Commercial |
$42.15
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Central Health Plan Commercial |
$168.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.31
|
| Rate for Payer: EPIC Health Plan Senior |
$84.31
|
| Rate for Payer: Galaxy Health WC |
$179.15
|
| Rate for Payer: Global Benefits Group Commercial |
$126.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.15
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Networks By Design Commercial |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$179.15
|
|
|
HC DRSNG ACTICOAT 4X10 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$210.77
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$189.69 |
| Rate for Payer: Adventist Health Commercial |
$42.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.60
|
| Rate for Payer: Blue Shield of California Commercial |
$133.63
|
| Rate for Payer: Blue Shield of California EPN |
$84.10
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Central Health Plan Commercial |
$168.62
|
| Rate for Payer: Cigna of CA HMO |
$134.89
|
| Rate for Payer: Cigna of CA PPO |
$155.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$179.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$179.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.31
|
| Rate for Payer: EPIC Health Plan Senior |
$84.31
|
| Rate for Payer: Galaxy Health WC |
$179.15
|
| Rate for Payer: Global Benefits Group Commercial |
$126.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.54
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Networks By Design Commercial |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$179.15
|
| Rate for Payer: Riverside University Health System MISP |
$84.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.39
|
| Rate for Payer: United Healthcare All Other HMO |
$105.39
|
| Rate for Payer: United Healthcare HMO Rider |
$105.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$179.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$179.15
|
| Rate for Payer: Vantage Medical Group Senior |
$179.15
|
|
|
HC DRSNG ACTICOAT 4X13 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$289.38
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901606857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$260.44 |
| Rate for Payer: Adventist Health Commercial |
$57.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.33
|
| Rate for Payer: Blue Shield of California Commercial |
$183.47
|
| Rate for Payer: Blue Shield of California EPN |
$115.46
|
| Rate for Payer: Cash Price |
$130.22
|
| Rate for Payer: Cash Price |
$130.22
|
| Rate for Payer: Central Health Plan Commercial |
$231.50
|
| Rate for Payer: Cigna of CA HMO |
$185.20
|
| Rate for Payer: Cigna of CA PPO |
$214.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$245.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$245.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$202.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.75
|
| Rate for Payer: EPIC Health Plan Senior |
$115.75
|
| Rate for Payer: Galaxy Health WC |
$245.97
|
| Rate for Payer: Global Benefits Group Commercial |
$173.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$183.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$170.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$202.57
|
| Rate for Payer: Multiplan Commercial |
$217.03
|
| Rate for Payer: Networks By Design Commercial |
$188.10
|
| Rate for Payer: Prime Health Services Commercial |
$245.97
|
| Rate for Payer: Riverside University Health System MISP |
$115.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$173.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.69
|
| Rate for Payer: United Healthcare All Other HMO |
$144.69
|
| Rate for Payer: United Healthcare HMO Rider |
$144.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$245.97
|
| Rate for Payer: Vantage Medical Group Senior |
$245.97
|
|
|
HC DRSNG ACTICOAT 4X13 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$289.38
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901606857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$260.44 |
| Rate for Payer: Adventist Health Commercial |
$57.88
|
| Rate for Payer: Cash Price |
$130.22
|
| Rate for Payer: Central Health Plan Commercial |
$231.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$202.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.75
|
| Rate for Payer: EPIC Health Plan Senior |
$115.75
|
| Rate for Payer: Galaxy Health WC |
$245.97
|
| Rate for Payer: Global Benefits Group Commercial |
$173.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$183.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$170.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.88
|
| Rate for Payer: Multiplan Commercial |
$217.03
|
| Rate for Payer: Networks By Design Commercial |
$188.10
|
| Rate for Payer: Prime Health Services Commercial |
$245.97
|
|
|
HC DRSNG ACTICOAT 4X4 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$133.91
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Adventist Health Commercial |
$26.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.90
|
| Rate for Payer: Blue Shield of California Commercial |
$84.90
|
| Rate for Payer: Blue Shield of California EPN |
$53.43
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Central Health Plan Commercial |
$107.13
|
| Rate for Payer: Cigna of CA HMO |
$85.70
|
| Rate for Payer: Cigna of CA PPO |
$99.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.56
|
| Rate for Payer: EPIC Health Plan Senior |
$53.56
|
| Rate for Payer: Galaxy Health WC |
$113.82
|
| Rate for Payer: Global Benefits Group Commercial |
$80.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$93.74
|
| Rate for Payer: Multiplan Commercial |
$100.43
|
| Rate for Payer: Networks By Design Commercial |
$87.04
|
| Rate for Payer: Prime Health Services Commercial |
$113.82
|
| Rate for Payer: Riverside University Health System MISP |
$53.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.95
|
| Rate for Payer: United Healthcare All Other HMO |
$66.95
|
| Rate for Payer: United Healthcare HMO Rider |
$66.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.82
|
| Rate for Payer: Vantage Medical Group Senior |
$113.82
|
|
|
HC DRSNG ACTICOAT 4X4 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$133.91
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Adventist Health Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Central Health Plan Commercial |
$107.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.56
|
| Rate for Payer: EPIC Health Plan Senior |
$53.56
|
| Rate for Payer: Galaxy Health WC |
$113.82
|
| Rate for Payer: Global Benefits Group Commercial |
$80.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.78
|
| Rate for Payer: Multiplan Commercial |
$100.43
|
| Rate for Payer: Networks By Design Commercial |
$87.04
|
| Rate for Payer: Prime Health Services Commercial |
$113.82
|
|
|
HC DRSNG ACTICOAT 4X8 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$194.95
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.99 |
| Max. Negotiated Rate |
$175.46 |
| Rate for Payer: Adventist Health Commercial |
$38.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.40
|
| Rate for Payer: Blue Shield of California Commercial |
$123.60
|
| Rate for Payer: Blue Shield of California EPN |
$77.79
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Central Health Plan Commercial |
$155.96
|
| Rate for Payer: Cigna of CA HMO |
$124.77
|
| Rate for Payer: Cigna of CA PPO |
$144.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.98
|
| Rate for Payer: EPIC Health Plan Senior |
$77.98
|
| Rate for Payer: Galaxy Health WC |
$165.71
|
| Rate for Payer: Global Benefits Group Commercial |
$116.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$136.47
|
| Rate for Payer: Multiplan Commercial |
$146.21
|
| Rate for Payer: Networks By Design Commercial |
$126.72
|
| Rate for Payer: Prime Health Services Commercial |
$165.71
|
| Rate for Payer: Riverside University Health System MISP |
$77.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.47
|
| Rate for Payer: United Healthcare All Other HMO |
$97.47
|
| Rate for Payer: United Healthcare HMO Rider |
$97.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.71
|
| Rate for Payer: Vantage Medical Group Senior |
$165.71
|
|
|
HC DRSNG ACTICOAT 4X8 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$194.95
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.99 |
| Max. Negotiated Rate |
$175.46 |
| Rate for Payer: Adventist Health Commercial |
$38.99
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Central Health Plan Commercial |
$155.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.98
|
| Rate for Payer: EPIC Health Plan Senior |
$77.98
|
| Rate for Payer: Galaxy Health WC |
$165.71
|
| Rate for Payer: Global Benefits Group Commercial |
$116.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Multiplan Commercial |
$146.21
|
| Rate for Payer: Networks By Design Commercial |
$126.72
|
| Rate for Payer: Prime Health Services Commercial |
$165.71
|
|
|
HC DRSNG ACTICOAT 4X8" FLX 3
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.47
|
| 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 Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.42
|
| Rate for Payer: Blue Shield of California Commercial |
$96.37
|
| Rate for Payer: Blue Shield of California EPN |
$60.65
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| 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: Health Management Network EPO/PPO |
$136.80
|
| 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 |
$30.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| 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 ACTICOAT 4X8" FLX 3
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| 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: Health Management Network EPO/PPO |
$136.80
|
| 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 |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC DRSNG ACTICOAT 8"X16" 231304
|
Facility
|
IP
|
$317.80
|
|
|
Service Code
|
CPT A6253
|
| Hospital Charge Code |
901698100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.56 |
| Max. Negotiated Rate |
$286.02 |
| Rate for Payer: Adventist Health Commercial |
$63.56
|
| Rate for Payer: Cash Price |
$143.01
|
| Rate for Payer: Central Health Plan Commercial |
$254.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.12
|
| Rate for Payer: EPIC Health Plan Senior |
$127.12
|
| Rate for Payer: Galaxy Health WC |
$270.13
|
| Rate for Payer: Global Benefits Group Commercial |
$190.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.56
|
| Rate for Payer: Multiplan Commercial |
$238.35
|
| Rate for Payer: Networks By Design Commercial |
$206.57
|
| Rate for Payer: Prime Health Services Commercial |
$270.13
|
|
|
HC DRSNG ACTICOAT 8"X16" 231304
|
Facility
|
OP
|
$317.80
|
|
|
Service Code
|
CPT A6253
|
| Hospital Charge Code |
901698100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$286.02 |
| Rate for Payer: Adventist Health Commercial |
$63.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$174.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$238.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$153.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.86
|
| Rate for Payer: Blue Shield of California Commercial |
$201.49
|
| Rate for Payer: Blue Shield of California EPN |
$126.80
|
| Rate for Payer: Cash Price |
$143.01
|
| Rate for Payer: Cash Price |
$143.01
|
| Rate for Payer: Central Health Plan Commercial |
$254.24
|
| Rate for Payer: Cigna of CA HMO |
$203.39
|
| Rate for Payer: Cigna of CA PPO |
$235.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$270.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$270.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.12
|
| Rate for Payer: EPIC Health Plan Senior |
$127.12
|
| Rate for Payer: Galaxy Health WC |
$270.13
|
| Rate for Payer: Global Benefits Group Commercial |
$190.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$201.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$222.46
|
| Rate for Payer: Multiplan Commercial |
$238.35
|
| Rate for Payer: Networks By Design Commercial |
$206.57
|
| Rate for Payer: Prime Health Services Commercial |
$270.13
|
| Rate for Payer: Riverside University Health System MISP |
$127.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.90
|
| Rate for Payer: United Healthcare All Other HMO |
$158.90
|
| Rate for Payer: United Healthcare HMO Rider |
$158.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$158.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$270.13
|
| Rate for Payer: Vantage Medical Group Senior |
$270.13
|
|
|
HC DRSNG ALLEVYN 2 3/8" X 4 3/4"
|
Facility
|
IP
|
$11.64
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901607772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Central Health Plan Commercial |
$9.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Senior |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$9.89
|
|
|
HC DRSNG ALLEVYN 2 3/8" X 4 3/4"
|
Facility
|
OP
|
$11.64
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901607772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.77
|
| Rate for Payer: Blue Shield of California Commercial |
$7.38
|
| Rate for Payer: Blue Shield of California EPN |
$4.64
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Central Health Plan Commercial |
$9.31
|
| Rate for Payer: Cigna of CA HMO |
$7.45
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Senior |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$9.89
|
| Rate for Payer: Riverside University Health System MISP |
$4.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO |
$5.82
|
| Rate for Payer: United Healthcare HMO Rider |
$5.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.89
|
| Rate for Payer: Vantage Medical Group Senior |
$9.89
|
|
|
HC DRSNG ALLEVYN GB LITE 2" X 2"
|
Facility
|
OP
|
$10.99
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901608075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.39
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Blue Shield of California EPN |
$4.39
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.79
|
| Rate for Payer: Cigna of CA HMO |
$7.03
|
| Rate for Payer: Cigna of CA PPO |
$8.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.34
|
| Rate for Payer: Global Benefits Group Commercial |
$6.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$8.24
|
| Rate for Payer: Networks By Design Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$9.34
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.34
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
|
|
HC DRSNG ALLEVYN GB LITE 2" X 2"
|
Facility
|
IP
|
$10.99
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901608075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.89 |
| Rate for Payer: Adventist Health Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.34
|
| Rate for Payer: Global Benefits Group Commercial |
$6.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.24
|
| Rate for Payer: Networks By Design Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$9.34
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 12"
|
Facility
|
OP
|
$50.35
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$45.31 |
| Rate for Payer: Adventist Health Commercial |
$10.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.29
|
| Rate for Payer: Blue Shield of California Commercial |
$31.92
|
| Rate for Payer: Blue Shield of California EPN |
$20.09
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Central Health Plan Commercial |
$40.28
|
| Rate for Payer: Cigna of CA HMO |
$32.22
|
| Rate for Payer: Cigna of CA PPO |
$37.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.14
|
| Rate for Payer: EPIC Health Plan Senior |
$20.14
|
| Rate for Payer: Galaxy Health WC |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$30.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.24
|
| Rate for Payer: Multiplan Commercial |
$37.76
|
| Rate for Payer: Networks By Design Commercial |
$32.73
|
| Rate for Payer: Prime Health Services Commercial |
$42.80
|
| Rate for Payer: Riverside University Health System MISP |
$20.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.18
|
| Rate for Payer: United Healthcare All Other HMO |
$25.18
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.80
|
| Rate for Payer: Vantage Medical Group Senior |
$42.80
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 12"
|
Facility
|
IP
|
$50.35
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$45.31 |
| Rate for Payer: Adventist Health Commercial |
$10.07
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Central Health Plan Commercial |
$40.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.14
|
| Rate for Payer: EPIC Health Plan Senior |
$20.14
|
| Rate for Payer: Galaxy Health WC |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$30.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.07
|
| Rate for Payer: Multiplan Commercial |
$37.76
|
| Rate for Payer: Networks By Design Commercial |
$32.73
|
| Rate for Payer: Prime Health Services Commercial |
$42.80
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 8"
|
Facility
|
IP
|
$30.50
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Adventist Health Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Central Health Plan Commercial |
$24.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.20
|
| Rate for Payer: Galaxy Health WC |
$25.93
|
| Rate for Payer: Global Benefits Group Commercial |
$18.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$22.88
|
| Rate for Payer: Networks By Design Commercial |
$19.82
|
| Rate for Payer: Prime Health Services Commercial |
$25.93
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 8"
|
Facility
|
OP
|
$30.50
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Adventist Health Commercial |
$6.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.74
|
| Rate for Payer: Blue Shield of California Commercial |
$19.34
|
| Rate for Payer: Blue Shield of California EPN |
$12.17
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Central Health Plan Commercial |
$24.40
|
| Rate for Payer: Cigna of CA HMO |
$19.52
|
| Rate for Payer: Cigna of CA PPO |
$22.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.20
|
| Rate for Payer: Galaxy Health WC |
$25.93
|
| Rate for Payer: Global Benefits Group Commercial |
$18.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.35
|
| Rate for Payer: Multiplan Commercial |
$22.88
|
| Rate for Payer: Networks By Design Commercial |
$19.82
|
| Rate for Payer: Prime Health Services Commercial |
$25.93
|
| Rate for Payer: Riverside University Health System MISP |
$12.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.25
|
| Rate for Payer: United Healthcare HMO Rider |
$15.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$25.93
|
|
