|
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
|
|
|
HC DRSNG HYDROFERA FOAM BLUE 4X5"
|
Facility
|
OP
|
$56.17
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$50.55 |
| Rate for Payer: Adventist Health Commercial |
$11.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.67
|
| Rate for Payer: Blue Shield of California Commercial |
$35.61
|
| Rate for Payer: Blue Shield of California EPN |
$22.41
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Central Health Plan Commercial |
$44.94
|
| Rate for Payer: Cigna of CA HMO |
$35.95
|
| Rate for Payer: Cigna of CA PPO |
$41.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.47
|
| Rate for Payer: EPIC Health Plan Senior |
$22.47
|
| Rate for Payer: Galaxy Health WC |
$47.74
|
| Rate for Payer: Global Benefits Group Commercial |
$33.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.32
|
| Rate for Payer: Multiplan Commercial |
$42.13
|
| Rate for Payer: Networks By Design Commercial |
$36.51
|
| Rate for Payer: Prime Health Services Commercial |
$47.74
|
| Rate for Payer: Riverside University Health System MISP |
$22.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.09
|
| Rate for Payer: United Healthcare All Other HMO |
$28.09
|
| Rate for Payer: United Healthcare HMO Rider |
$28.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.74
|
| Rate for Payer: Vantage Medical Group Senior |
$47.74
|
|
|
HC DRSNG HYDROFERA FOAM BLUE 4X5"
|
Facility
|
IP
|
$56.17
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$50.55 |
| Rate for Payer: Adventist Health Commercial |
$11.23
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Central Health Plan Commercial |
$44.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.47
|
| Rate for Payer: EPIC Health Plan Senior |
$22.47
|
| Rate for Payer: Galaxy Health WC |
$47.74
|
| Rate for Payer: Global Benefits Group Commercial |
$33.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$42.13
|
| Rate for Payer: Networks By Design Commercial |
$36.51
|
| Rate for Payer: Prime Health Services Commercial |
$47.74
|
|
|
HC DRSNG HYDROGEL 2.4X2.4"
|
Facility
|
OP
|
$35.75
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901698329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.80
|
| Rate for Payer: Blue Shield of California Commercial |
$22.67
|
| Rate for Payer: Blue Shield of California EPN |
$14.26
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: Cigna of CA HMO |
$22.88
|
| Rate for Payer: Cigna of CA PPO |
$26.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.02
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
| Rate for Payer: Riverside University Health System MISP |
$14.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17.88
|
| Rate for Payer: United Healthcare HMO Rider |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC DRSNG HYDROGEL 2.4X2.4"
|
Facility
|
IP
|
$35.75
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901698329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Adventist Health Commercial |
$7.15
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Senior |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
|
|
HC DRSNG HYDROGEL MCKESSN 4X4" SQ
|
Facility
|
IP
|
$38.54
|
|
| Hospital Charge Code |
901698647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$34.69 |
| Rate for Payer: Adventist Health Commercial |
$7.71
|
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: Central Health Plan Commercial |
$30.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.42
|
| Rate for Payer: EPIC Health Plan Senior |
$15.42
|
| Rate for Payer: Galaxy Health WC |
$32.76
|
| Rate for Payer: Global Benefits Group Commercial |
$23.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.71
|
| Rate for Payer: Multiplan Commercial |
$28.91
|
| Rate for Payer: Networks By Design Commercial |
$25.05
|
| Rate for Payer: Prime Health Services Commercial |
$32.76
|
|
|
HC DRSNG HYDROGEL MCKESSN 4X4" SQ
|
Facility
|
OP
|
$38.54
|
|
| Hospital Charge Code |
901698647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$34.69 |
| Rate for Payer: Adventist Health Commercial |
$7.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.42
|
| Rate for Payer: Blue Shield of California Commercial |
$24.43
|
| Rate for Payer: Blue Shield of California EPN |
$15.38
|
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: Central Health Plan Commercial |
$30.83
|
| Rate for Payer: Cigna of CA HMO |
$24.67
|
| Rate for Payer: Cigna of CA PPO |
$28.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.42
|
| Rate for Payer: EPIC Health Plan Senior |
$15.42
|
| Rate for Payer: Galaxy Health WC |
$32.76
|
| Rate for Payer: Global Benefits Group Commercial |
$23.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.98
|
| Rate for Payer: Multiplan Commercial |
$28.91
|
| Rate for Payer: Networks By Design Commercial |
$25.05
|
| Rate for Payer: Prime Health Services Commercial |
$32.76
|
| Rate for Payer: Riverside University Health System MISP |
$15.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.27
|
| Rate for Payer: United Healthcare All Other HMO |
$19.27
|
| Rate for Payer: United Healthcare HMO Rider |
$19.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.76
|
| Rate for Payer: Vantage Medical Group Senior |
$32.76
|
|
|
HC DRSNG INTERDRY 10X36 IN SHEET
|
Facility
|
IP
|
$262.43
|
|
| Hospital Charge Code |
901607341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$236.19 |
| Rate for Payer: Adventist Health Commercial |
$52.49
|
| Rate for Payer: Cash Price |
$118.09
|
| Rate for Payer: Central Health Plan Commercial |
$209.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.97
|
| Rate for Payer: EPIC Health Plan Senior |
$104.97
|
| Rate for Payer: Galaxy Health WC |
$223.07
|
| Rate for Payer: Global Benefits Group Commercial |
$157.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.49
|
| Rate for Payer: Multiplan Commercial |
$196.82
|
| Rate for Payer: Networks By Design Commercial |
$170.58
|
| Rate for Payer: Prime Health Services Commercial |
$223.07
|
|
|
HC DRSNG INTERDRY 10X36 IN SHEET
|
Facility
|
OP
|
$262.43
|
|
| Hospital Charge Code |
901607341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$236.19 |
| Rate for Payer: Adventist Health Commercial |
$52.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.66
|
| Rate for Payer: Blue Shield of California Commercial |
$166.38
|
| Rate for Payer: Blue Shield of California EPN |
$104.71
|
| Rate for Payer: Cash Price |
$118.09
|
| Rate for Payer: Central Health Plan Commercial |
$209.94
|
| Rate for Payer: Cigna of CA HMO |
$167.96
|
| Rate for Payer: Cigna of CA PPO |
$194.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$223.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.97
|
| Rate for Payer: EPIC Health Plan Senior |
$104.97
|
| Rate for Payer: Galaxy Health WC |
$223.07
|
| Rate for Payer: Global Benefits Group Commercial |
$157.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.70
|
| Rate for Payer: Multiplan Commercial |
$196.82
|
| Rate for Payer: Networks By Design Commercial |
$170.58
|
| Rate for Payer: Prime Health Services Commercial |
$223.07
|
| Rate for Payer: Riverside University Health System MISP |
$104.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.22
|
| Rate for Payer: United Healthcare All Other HMO |
$131.22
|
| Rate for Payer: United Healthcare HMO Rider |
$131.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$223.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.07
|
| Rate for Payer: Vantage Medical Group Senior |
$223.07
|
|
|
HC DRSNG IV TEGADERM BRDR 2X2.25"
|
Facility
|
OP
|
$2.30
|
|
| Hospital Charge Code |
901698417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1.46
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Central Health Plan Commercial |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: Riverside University Health System MISP |
$0.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
HC DRSNG IV TEGADERM BRDR 2X2.25"
|
Facility
|
IP
|
$2.30
|
|
| Hospital Charge Code |
901698417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Central Health Plan Commercial |
$1.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$1.73
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 1.75X1.75CM
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.79 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$394.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$303.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.29
|
| Rate for Payer: Blue Shield of California Commercial |
$523.68
|
| Rate for Payer: Blue Shield of California EPN |
$329.57
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Central Health Plan Commercial |
$660.80
|
| Rate for Payer: Cigna of CA HMO |
$578.20
|
| Rate for Payer: Cigna of CA PPO |
$578.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$743.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$524.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: Networks By Design Commercial |
$413.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.00
|
| Rate for Payer: United Healthcare All Other HMO |
$301.74
|
| Rate for Payer: United Healthcare HMO Rider |
$295.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 1.75X1.75CM
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Blue Shield of California Commercial |
$662.45
|
| Rate for Payer: Blue Shield of California EPN |
$416.30
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Central Health Plan Commercial |
$660.80
|
| Rate for Payer: Cigna of CA HMO |
$578.20
|
| Rate for Payer: Cigna of CA PPO |
$578.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$743.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$524.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: Networks By Design Commercial |
$413.00
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.00
|
| Rate for Payer: United Healthcare All Other HMO |
$301.74
|
| Rate for Payer: United Healthcare HMO Rider |
$295.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.51
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 3 X 3.5CM
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Blue Shield of California Commercial |
$237.39
|
| Rate for Payer: Blue Shield of California EPN |
$149.18
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$148.00
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.09
|
| Rate for Payer: United Healthcare All Other HMO |
$108.13
|
| Rate for Payer: United Healthcare HMO Rider |
$105.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.94
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 3 X 3.5CM
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$394.22 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$394.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$303.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.29
|
| Rate for Payer: Blue Shield of California Commercial |
$187.66
|
| Rate for Payer: Blue Shield of California EPN |
$118.10
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$148.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.09
|
| Rate for Payer: United Healthcare All Other HMO |
$108.13
|
| Rate for Payer: United Healthcare HMO Rider |
$105.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 3 X 7CM
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Blue Shield of California Commercial |
$149.17
|
| Rate for Payer: Blue Shield of California EPN |
$93.74
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: Cigna of CA HMO |
$130.20
|
| Rate for Payer: Cigna of CA PPO |
$130.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Senior |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$93.00
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.81
|
| Rate for Payer: United Healthcare All Other HMO |
$67.95
|
| Rate for Payer: United Healthcare HMO Rider |
$66.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.91
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 3 X 7CM
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$394.22 |
| Rate for Payer: Adventist Health Commercial |
$37.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$394.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$303.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.29
|
| Rate for Payer: Blue Shield of California Commercial |
$117.92
|
| Rate for Payer: Blue Shield of California EPN |
$74.21
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: Cigna of CA HMO |
$130.20
|
| Rate for Payer: Cigna of CA PPO |
$130.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$93.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.81
|
| Rate for Payer: United Healthcare All Other HMO |
$67.95
|
| Rate for Payer: United Healthcare HMO Rider |
$66.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC DRSNG MEDIPORE ADHSV 3-1/2"X6"
|
Facility
|
IP
|
$5.90
|
|
|
Service Code
|
CPT A6220
|
| Hospital Charge Code |
901698616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Central Health Plan Commercial |
$4.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
|
|
HC DRSNG MEDIPORE ADHSV 3-1/2"X6"
|
Facility
|
OP
|
$5.90
|
|
|
Service Code
|
CPT A6220
|
| Hospital Charge Code |
901698616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.43
|
| Rate for Payer: Blue Shield of California Commercial |
$3.74
|
| Rate for Payer: Blue Shield of California EPN |
$2.35
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Central Health Plan Commercial |
$4.72
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Riverside University Health System MISP |
$2.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
HC DRSNG MEPILEX 4X4
|
Facility
|
OP
|
$18.53
|
|
| Hospital Charge Code |
901602023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$16.68 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.78
|
| Rate for Payer: Blue Shield of California Commercial |
$11.75
|
| Rate for Payer: Blue Shield of California EPN |
$7.39
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.82
|
| Rate for Payer: Cigna of CA HMO |
$11.86
|
| Rate for Payer: Cigna of CA PPO |
$13.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.41
|
| Rate for Payer: EPIC Health Plan Senior |
$7.41
|
| Rate for Payer: Galaxy Health WC |
$15.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.97
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.04
|
| Rate for Payer: Prime Health Services Commercial |
$15.75
|
| Rate for Payer: Riverside University Health System MISP |
$7.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.27
|
| Rate for Payer: United Healthcare All Other HMO |
$9.27
|
| Rate for Payer: United Healthcare HMO Rider |
$9.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$15.75
|
|
|
HC DRSNG MEPILEX 4X4
|
Facility
|
IP
|
$18.53
|
|
| Hospital Charge Code |
901602023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$16.68 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.41
|
| Rate for Payer: EPIC Health Plan Senior |
$7.41
|
| Rate for Payer: Galaxy Health WC |
$15.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.04
|
| Rate for Payer: Prime Health Services Commercial |
$15.75
|
|
|
HC DRSNG MEPILEX BORDER 3X3"
|
Facility
|
OP
|
$16.56
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.63
|
| Rate for Payer: Blue Shield of California Commercial |
$10.50
|
| Rate for Payer: Blue Shield of California EPN |
$6.61
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Riverside University Health System MISP |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
HC DRSNG MEPILEX BORDER 3X3"
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
HC DRSNG MEPILEX BORDER 4X10"
|
Facility
|
IP
|
$38.46
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$34.61 |
| Rate for Payer: Adventist Health Commercial |
$7.69
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Central Health Plan Commercial |
$30.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Senior |
$15.38
|
| Rate for Payer: Galaxy Health WC |
$32.69
|
| Rate for Payer: Global Benefits Group Commercial |
$23.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$28.84
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$32.69
|
|
|
HC DRSNG MEPILEX BORDER 4X10"
|
Facility
|
OP
|
$38.46
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Adventist Health Commercial |
$7.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.37
|
| Rate for Payer: Blue Shield of California Commercial |
$24.38
|
| Rate for Payer: Blue Shield of California EPN |
$15.35
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Central Health Plan Commercial |
$30.77
|
| Rate for Payer: Cigna of CA HMO |
$24.61
|
| Rate for Payer: Cigna of CA PPO |
$28.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Senior |
$15.38
|
| Rate for Payer: Galaxy Health WC |
$32.69
|
| Rate for Payer: Global Benefits Group Commercial |
$23.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.92
|
| Rate for Payer: Multiplan Commercial |
$28.84
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$32.69
|
| Rate for Payer: Riverside University Health System MISP |
$15.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.23
|
| Rate for Payer: United Healthcare All Other HMO |
$19.23
|
| Rate for Payer: United Healthcare HMO Rider |
$19.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.69
|
| Rate for Payer: Vantage Medical Group Senior |
$32.69
|
|
