|
HC DRSNG FOAM MEPILEX 3X3" FLEX
|
Facility
|
IP
|
$15.58
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$14.02 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Central Health Plan Commercial |
$12.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Senior |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
|
|
HC DRSNG FOAM MEPILEX 3X3" FLEX
|
Facility
|
OP
|
$15.58
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.06
|
| Rate for Payer: Blue Shield of California Commercial |
$9.88
|
| Rate for Payer: Blue Shield of California EPN |
$6.22
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Central Health Plan Commercial |
$12.46
|
| Rate for Payer: Cigna of CA HMO |
$9.97
|
| Rate for Payer: Cigna of CA PPO |
$11.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Senior |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
| Rate for Payer: Riverside University Health System MISP |
$6.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.79
|
| Rate for Payer: United Healthcare All Other HMO |
$7.79
|
| Rate for Payer: United Healthcare HMO Rider |
$7.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.24
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC DRSNG FOAM MEPILEX 4X4" FLEX
|
Facility
|
IP
|
$21.16
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$9.52
|
| Rate for Payer: Central Health Plan Commercial |
$16.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
|
|
HC DRSNG FOAM MEPILEX 4X4" FLEX
|
Facility
|
OP
|
$21.16
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.31
|
| Rate for Payer: Blue Shield of California Commercial |
$13.42
|
| Rate for Payer: Blue Shield of California EPN |
$8.44
|
| Rate for Payer: Cash Price |
$9.52
|
| Rate for Payer: Cash Price |
$9.52
|
| Rate for Payer: Central Health Plan Commercial |
$16.93
|
| Rate for Payer: Cigna of CA HMO |
$13.54
|
| Rate for Payer: Cigna of CA PPO |
$15.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.81
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
| Rate for Payer: Riverside University Health System MISP |
$8.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.99
|
| Rate for Payer: Vantage Medical Group Senior |
$17.99
|
|
|
HC DRSNG FOAM MEPILEX 6X6" FLEX
|
Facility
|
IP
|
$35.92
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$32.33 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Central Health Plan Commercial |
$28.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.37
|
| Rate for Payer: Galaxy Health WC |
$30.53
|
| Rate for Payer: Global Benefits Group Commercial |
$21.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.18
|
| Rate for Payer: Multiplan Commercial |
$26.94
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
|
|
HC DRSNG FOAM MEPILEX 6X6" FLEX
|
Facility
|
OP
|
$35.92
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.89
|
| Rate for Payer: Blue Shield of California Commercial |
$22.77
|
| Rate for Payer: Blue Shield of California EPN |
$14.33
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Central Health Plan Commercial |
$28.74
|
| Rate for Payer: Cigna of CA HMO |
$22.99
|
| Rate for Payer: Cigna of CA PPO |
$26.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.37
|
| Rate for Payer: Galaxy Health WC |
$30.53
|
| Rate for Payer: Global Benefits Group Commercial |
$21.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.14
|
| Rate for Payer: Multiplan Commercial |
$26.94
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
| Rate for Payer: Riverside University Health System MISP |
$14.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.96
|
| Rate for Payer: United Healthcare HMO Rider |
$17.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.53
|
| Rate for Payer: Vantage Medical Group Senior |
$30.53
|
|
|
HC DRSNG FOAM MEPILEX 6X8" FLEX
|
Facility
|
OP
|
$44.28
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Adventist Health Commercial |
$8.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.76
|
| Rate for Payer: Blue Shield of California Commercial |
$28.07
|
| Rate for Payer: Blue Shield of California EPN |
$17.67
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Central Health Plan Commercial |
$35.42
|
| Rate for Payer: Cigna of CA HMO |
$28.34
|
| Rate for Payer: Cigna of CA PPO |
$32.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.71
|
| Rate for Payer: EPIC Health Plan Senior |
$17.71
|
| Rate for Payer: Galaxy Health WC |
$37.64
|
| Rate for Payer: Global Benefits Group Commercial |
$26.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$33.21
|
| Rate for Payer: Networks By Design Commercial |
$28.78
|
| Rate for Payer: Prime Health Services Commercial |
$37.64
|
| Rate for Payer: Riverside University Health System MISP |
$17.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$22.14
|
| Rate for Payer: United Healthcare HMO Rider |
$22.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Vantage Medical Group Senior |
$37.64
|
|
|
HC DRSNG FOAM MEPILEX 6X8" FLEX
|
Facility
|
IP
|
$44.28
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Adventist Health Commercial |
$8.86
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Central Health Plan Commercial |
$35.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.71
|
| Rate for Payer: EPIC Health Plan Senior |
$17.71
|
| Rate for Payer: Galaxy Health WC |
$37.64
|
| Rate for Payer: Global Benefits Group Commercial |
$26.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$33.21
|
| Rate for Payer: Networks By Design Commercial |
$28.78
|
| Rate for Payer: Prime Health Services Commercial |
$37.64
|
|
|
HC DRSNG GAUZE NON-ADHERENT 3X3"
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
HC DRSNG GAUZE NON-ADHERENT 3X3"
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Riverside University Health System MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
HC DRSNG GAUZE NON-ADHERENT 3X8"
|
Facility
|
OP
|
$2.38
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$6.07 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1.51
|
| Rate for Payer: Blue Shield of California EPN |
$0.95
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$1.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
| Rate for Payer: Riverside University Health System MISP |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2.02
|
|
|
HC DRSNG GAUZE NON-ADHERENT 3X8"
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Adventist Health Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Senior |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
|
|
HC DRSNG GAUZE PETROLATM 3X36"
|
Facility
|
IP
|
$115.22
|
|
|
Service Code
|
CPT A6224
|
| Hospital Charge Code |
901698173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$23.04
|
| Rate for Payer: Cash Price |
$51.85
|
| Rate for Payer: Central Health Plan Commercial |
$92.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.09
|
| Rate for Payer: EPIC Health Plan Senior |
$46.09
|
| Rate for Payer: Galaxy Health WC |
$97.94
|
| Rate for Payer: Global Benefits Group Commercial |
$69.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$86.42
|
| Rate for Payer: Networks By Design Commercial |
$74.89
|
| Rate for Payer: Prime Health Services Commercial |
$97.94
|
|
|
HC DRSNG GAUZE PETROLATM 3X36"
|
Facility
|
OP
|
$115.22
|
|
|
Service Code
|
CPT A6224
|
| Hospital Charge Code |
901698173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.08 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Adventist Health Commercial |
$23.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.02
|
| Rate for Payer: Blue Shield of California Commercial |
$73.05
|
| Rate for Payer: Blue Shield of California EPN |
$45.97
|
| Rate for Payer: Cash Price |
$51.85
|
| Rate for Payer: Cash Price |
$51.85
|
| Rate for Payer: Central Health Plan Commercial |
$92.18
|
| Rate for Payer: Cigna of CA HMO |
$73.74
|
| Rate for Payer: Cigna of CA PPO |
$85.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.09
|
| Rate for Payer: EPIC Health Plan Senior |
$46.09
|
| Rate for Payer: Galaxy Health WC |
$97.94
|
| Rate for Payer: Global Benefits Group Commercial |
$69.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.65
|
| Rate for Payer: Multiplan Commercial |
$86.42
|
| Rate for Payer: Networks By Design Commercial |
$74.89
|
| Rate for Payer: Prime Health Services Commercial |
$97.94
|
| Rate for Payer: Riverside University Health System MISP |
$46.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.61
|
| Rate for Payer: United Healthcare All Other HMO |
$57.61
|
| Rate for Payer: United Healthcare HMO Rider |
$57.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.94
|
| Rate for Payer: Vantage Medical Group Senior |
$97.94
|
|
|
HC DRSNG GAUZE SPONGE 3X3 HRMT
|
Facility
|
IP
|
$0.49
|
|
| Hospital Charge Code |
901692015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
HC DRSNG GAUZE SPONGE 3X3 HRMT
|
Facility
|
OP
|
$0.49
|
|
| Hospital Charge Code |
901692015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
HC DRSNG GAUZE XEROFRM 1X8"
|
Facility
|
IP
|
$2.79
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Central Health Plan Commercial |
$2.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$2.37
|
|
|
HC DRSNG GAUZE XEROFRM 1X8"
|
Facility
|
OP
|
$2.79
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Adventist Health Commercial |
$0.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.77
|
| Rate for Payer: Blue Shield of California EPN |
$1.11
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Central Health Plan Commercial |
$2.23
|
| Rate for Payer: Cigna of CA HMO |
$1.79
|
| Rate for Payer: Cigna of CA PPO |
$2.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1.12
|
| Rate for Payer: Galaxy Health WC |
$2.37
|
| Rate for Payer: Global Benefits Group Commercial |
$1.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$2.09
|
| Rate for Payer: Networks By Design Commercial |
$1.81
|
| Rate for Payer: Prime Health Services Commercial |
$2.37
|
| Rate for Payer: Riverside University Health System MISP |
$1.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.37
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
HC DRSNG GAUZE XEROFRM 5X9"
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Central Health Plan Commercial |
$3.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
|
|
HC DRSNG GAUZE XEROFRM 5X9"
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$6.07 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2.76
|
| Rate for Payer: Blue Shield of California EPN |
$1.74
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Central Health Plan Commercial |
$3.48
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$3.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.26
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
| Rate for Payer: Riverside University Health System MISP |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO |
$2.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.70
|
|
|
HC DRSNG HEMOSTAT SURGICEL 1X2
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901603833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC DRSNG HEMOSTAT SURGICEL 1X2
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901603833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$221.90
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC DRSNG HEMOSTAT SURGICEL 2X14
|
Facility
|
IP
|
$359.14
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901604356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.83 |
| Max. Negotiated Rate |
$323.23 |
| Rate for Payer: Adventist Health Commercial |
$71.83
|
| Rate for Payer: Cash Price |
$161.61
|
| Rate for Payer: Central Health Plan Commercial |
$287.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$251.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.66
|
| Rate for Payer: EPIC Health Plan Senior |
$143.66
|
| Rate for Payer: Galaxy Health WC |
$305.27
|
| Rate for Payer: Global Benefits Group Commercial |
$215.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$323.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$228.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.83
|
| Rate for Payer: Multiplan Commercial |
$269.36
|
| Rate for Payer: Networks By Design Commercial |
$233.44
|
| Rate for Payer: Prime Health Services Commercial |
$305.27
|
|
|
HC DRSNG HEMOSTAT SURGICEL 2X14
|
Facility
|
OP
|
$359.14
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901604356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$323.23 |
| Rate for Payer: Adventist Health Commercial |
$71.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$305.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$269.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$173.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.91
|
| Rate for Payer: Blue Shield of California Commercial |
$227.69
|
| Rate for Payer: Blue Shield of California EPN |
$143.30
|
| Rate for Payer: Cash Price |
$161.61
|
| Rate for Payer: Cash Price |
$161.61
|
| Rate for Payer: Central Health Plan Commercial |
$287.31
|
| Rate for Payer: Cigna of CA HMO |
$229.85
|
| Rate for Payer: Cigna of CA PPO |
$265.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$305.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$305.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$251.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.66
|
| Rate for Payer: EPIC Health Plan Senior |
$143.66
|
| Rate for Payer: Galaxy Health WC |
$305.27
|
| Rate for Payer: Global Benefits Group Commercial |
$215.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$323.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$228.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$251.40
|
| Rate for Payer: Multiplan Commercial |
$269.36
|
| Rate for Payer: Networks By Design Commercial |
$233.44
|
| Rate for Payer: Prime Health Services Commercial |
$305.27
|
| Rate for Payer: Riverside University Health System MISP |
$143.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$215.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$215.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.57
|
| Rate for Payer: United Healthcare All Other HMO |
$179.57
|
| Rate for Payer: United Healthcare HMO Rider |
$179.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.27
|
| Rate for Payer: Vantage Medical Group Senior |
$305.27
|
|
|
HC DRSNG HEMOSTAT SURGICEL 2X3
|
Facility
|
OP
|
$254.45
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901603931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: Adventist Health Commercial |
$50.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$190.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.01
|
| Rate for Payer: Blue Shield of California Commercial |
$161.32
|
| Rate for Payer: Blue Shield of California EPN |
$101.53
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Central Health Plan Commercial |
$203.56
|
| Rate for Payer: Cigna of CA HMO |
$162.85
|
| Rate for Payer: Cigna of CA PPO |
$188.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$216.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$178.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.78
|
| Rate for Payer: EPIC Health Plan Senior |
$101.78
|
| Rate for Payer: Galaxy Health WC |
$216.28
|
| Rate for Payer: Global Benefits Group Commercial |
$152.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$161.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$150.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$178.12
|
| Rate for Payer: Multiplan Commercial |
$190.84
|
| Rate for Payer: Networks By Design Commercial |
$165.39
|
| Rate for Payer: Prime Health Services Commercial |
$216.28
|
| Rate for Payer: Riverside University Health System MISP |
$101.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.22
|
| Rate for Payer: United Healthcare All Other HMO |
$127.22
|
| Rate for Payer: United Healthcare HMO Rider |
$127.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.28
|
| Rate for Payer: Vantage Medical Group Senior |
$216.28
|
|
