|
HC DRSNG QUICKCLOT HEMO 4X4"
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
901698425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC DRSNG QUICKCLOT HEMO 4X4"
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
901698425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.42
|
| Rate for Payer: Blue Shield of California Commercial |
$96.37
|
| Rate for Payer: Blue Shield of California EPN |
$60.65
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC DRSNG QUICKCLOT Z-FOLD
|
Facility
|
IP
|
$304.92
|
|
| Hospital Charge Code |
901608008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$274.43 |
| Rate for Payer: Adventist Health Commercial |
$60.98
|
| Rate for Payer: Cash Price |
$137.21
|
| Rate for Payer: Central Health Plan Commercial |
$243.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$213.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.97
|
| Rate for Payer: EPIC Health Plan Senior |
$121.97
|
| Rate for Payer: Galaxy Health WC |
$259.18
|
| Rate for Payer: Global Benefits Group Commercial |
$182.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$193.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.98
|
| Rate for Payer: Multiplan Commercial |
$228.69
|
| Rate for Payer: Networks By Design Commercial |
$198.20
|
| Rate for Payer: Prime Health Services Commercial |
$259.18
|
|
|
HC DRSNG QUICKCLOT Z-FOLD
|
Facility
|
OP
|
$304.92
|
|
| Hospital Charge Code |
901608008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$274.43 |
| Rate for Payer: Adventist Health Commercial |
$60.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.37
|
| Rate for Payer: Blue Shield of California Commercial |
$193.32
|
| Rate for Payer: Blue Shield of California EPN |
$121.66
|
| Rate for Payer: Cash Price |
$137.21
|
| Rate for Payer: Central Health Plan Commercial |
$243.94
|
| Rate for Payer: Cigna of CA HMO |
$195.15
|
| Rate for Payer: Cigna of CA PPO |
$225.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$213.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.97
|
| Rate for Payer: EPIC Health Plan Senior |
$121.97
|
| Rate for Payer: Galaxy Health WC |
$259.18
|
| Rate for Payer: Global Benefits Group Commercial |
$182.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$193.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$213.44
|
| Rate for Payer: Multiplan Commercial |
$228.69
|
| Rate for Payer: Networks By Design Commercial |
$198.20
|
| Rate for Payer: Prime Health Services Commercial |
$259.18
|
| Rate for Payer: Riverside University Health System MISP |
$121.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.46
|
| Rate for Payer: United Healthcare All Other HMO |
$152.46
|
| Rate for Payer: United Healthcare HMO Rider |
$152.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.18
|
| Rate for Payer: Vantage Medical Group Senior |
$259.18
|
|
|
HC DRSNG RENASYS ABD KIT
|
Facility
|
OP
|
$224.70
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$202.23 |
| Rate for Payer: Adventist Health Commercial |
$44.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.71
|
| Rate for Payer: Blue Shield of California Commercial |
$142.46
|
| Rate for Payer: Blue Shield of California EPN |
$89.66
|
| Rate for Payer: Cash Price |
$101.12
|
| Rate for Payer: Cash Price |
$101.12
|
| Rate for Payer: Central Health Plan Commercial |
$179.76
|
| Rate for Payer: Cigna of CA HMO |
$143.81
|
| Rate for Payer: Cigna of CA PPO |
$166.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.88
|
| Rate for Payer: EPIC Health Plan Senior |
$89.88
|
| Rate for Payer: Galaxy Health WC |
$191.00
|
| Rate for Payer: Global Benefits Group Commercial |
$134.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$157.29
|
| Rate for Payer: Multiplan Commercial |
$168.53
|
| Rate for Payer: Networks By Design Commercial |
$146.06
|
| Rate for Payer: Prime Health Services Commercial |
$191.00
|
| Rate for Payer: Riverside University Health System MISP |
$89.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.35
|
| Rate for Payer: United Healthcare All Other HMO |
$112.35
|
| Rate for Payer: United Healthcare HMO Rider |
$112.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.00
|
| Rate for Payer: Vantage Medical Group Senior |
$191.00
|
|
|
HC DRSNG RENASYS ABD KIT
|
Facility
|
IP
|
$224.70
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$202.23 |
| Rate for Payer: Adventist Health Commercial |
$44.94
|
| Rate for Payer: Cash Price |
$101.12
|
| Rate for Payer: Central Health Plan Commercial |
$179.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$157.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.88
|
| Rate for Payer: EPIC Health Plan Senior |
$89.88
|
| Rate for Payer: Galaxy Health WC |
$191.00
|
| Rate for Payer: Global Benefits Group Commercial |
$134.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$142.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$132.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.94
|
| Rate for Payer: Multiplan Commercial |
$168.53
|
| Rate for Payer: Networks By Design Commercial |
$146.06
|
| Rate for Payer: Prime Health Services Commercial |
$191.00
|
|
|
HC DRSNG RENASYS F-FOAM LG KIT
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698186
|
|
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 RENASYS F-FOAM LG KIT
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| 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 RENSASYS F-FOAM SM KIT
|
Facility
|
IP
|
$47.48
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$9.50
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Central Health Plan Commercial |
$37.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: EPIC Health Plan Senior |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$35.61
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
|
|
HC DRSNG RENSASYS F-FOAM SM KIT
|
Facility
|
OP
|
$47.48
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$59.52 |
| Rate for Payer: Adventist Health Commercial |
$9.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.62
|
| Rate for Payer: Blue Shield of California Commercial |
$30.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.94
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Central Health Plan Commercial |
$37.98
|
| Rate for Payer: Cigna of CA HMO |
$30.39
|
| Rate for Payer: Cigna of CA PPO |
$35.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: EPIC Health Plan Senior |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.24
|
| Rate for Payer: Multiplan Commercial |
$35.61
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
| Rate for Payer: Riverside University Health System MISP |
$18.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.74
|
| Rate for Payer: United Healthcare All Other HMO |
$23.74
|
| Rate for Payer: United Healthcare HMO Rider |
$23.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.36
|
| Rate for Payer: Vantage Medical Group Senior |
$40.36
|
|
|
HC DRSNG SHEET 2X2 HD THERAHONEY
|
Facility
|
OP
|
$29.19
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901698902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$26.27 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.98
|
| Rate for Payer: Blue Shield of California Commercial |
$18.51
|
| Rate for Payer: Blue Shield of California EPN |
$11.65
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Central Health Plan Commercial |
$23.35
|
| Rate for Payer: Cigna of CA HMO |
$18.68
|
| Rate for Payer: Cigna of CA PPO |
$21.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11.68
|
| Rate for Payer: Galaxy Health WC |
$24.81
|
| Rate for Payer: Global Benefits Group Commercial |
$17.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.43
|
| Rate for Payer: Multiplan Commercial |
$21.89
|
| Rate for Payer: Networks By Design Commercial |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$24.81
|
| Rate for Payer: Riverside University Health System MISP |
$11.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.60
|
| Rate for Payer: United Healthcare All Other HMO |
$14.60
|
| Rate for Payer: United Healthcare HMO Rider |
$14.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.81
|
|
|
HC DRSNG SHEET 2X2 HD THERAHONEY
|
Facility
|
IP
|
$29.19
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901698902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$26.27 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Central Health Plan Commercial |
$23.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11.68
|
| Rate for Payer: Galaxy Health WC |
$24.81
|
| Rate for Payer: Global Benefits Group Commercial |
$17.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Multiplan Commercial |
$21.89
|
| Rate for Payer: Networks By Design Commercial |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$24.81
|
|
|
HC DRSNG SHEET 4X5 HD THERAHONEY
|
Facility
|
IP
|
$66.17
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$59.55 |
| Rate for Payer: Adventist Health Commercial |
$13.23
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Central Health Plan Commercial |
$52.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.47
|
| Rate for Payer: EPIC Health Plan Senior |
$26.47
|
| Rate for Payer: Galaxy Health WC |
$56.24
|
| Rate for Payer: Global Benefits Group Commercial |
$39.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Multiplan Commercial |
$49.63
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$56.24
|
|
|
HC DRSNG SHEET 4X5 HD THERAHONEY
|
Facility
|
OP
|
$66.17
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$59.55 |
| Rate for Payer: Adventist Health Commercial |
$13.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.49
|
| Rate for Payer: Blue Shield of California Commercial |
$41.95
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Central Health Plan Commercial |
$52.94
|
| Rate for Payer: Cigna of CA HMO |
$42.35
|
| Rate for Payer: Cigna of CA PPO |
$48.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.47
|
| Rate for Payer: EPIC Health Plan Senior |
$26.47
|
| Rate for Payer: Galaxy Health WC |
$56.24
|
| Rate for Payer: Global Benefits Group Commercial |
$39.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46.32
|
| Rate for Payer: Multiplan Commercial |
$49.63
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$56.24
|
| Rate for Payer: Riverside University Health System MISP |
$26.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.09
|
| Rate for Payer: United Healthcare All Other HMO |
$33.09
|
| Rate for Payer: United Healthcare HMO Rider |
$33.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.24
|
| Rate for Payer: Vantage Medical Group Senior |
$56.24
|
|
|
HC DRSNG SHEET 4X5 THERAHONEY
|
Facility
|
IP
|
$48.79
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$43.91 |
| Rate for Payer: Adventist Health Commercial |
$9.76
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Central Health Plan Commercial |
$39.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.52
|
| Rate for Payer: EPIC Health Plan Senior |
$19.52
|
| Rate for Payer: Galaxy Health WC |
$41.47
|
| Rate for Payer: Global Benefits Group Commercial |
$29.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$36.59
|
| Rate for Payer: Networks By Design Commercial |
$31.71
|
| Rate for Payer: Prime Health Services Commercial |
$41.47
|
|
|
HC DRSNG SHEET 4X5 THERAHONEY
|
Facility
|
OP
|
$48.79
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$43.91 |
| Rate for Payer: Adventist Health Commercial |
$9.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.38
|
| Rate for Payer: Blue Shield of California Commercial |
$30.93
|
| Rate for Payer: Blue Shield of California EPN |
$19.47
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Central Health Plan Commercial |
$39.03
|
| Rate for Payer: Cigna of CA HMO |
$31.23
|
| Rate for Payer: Cigna of CA PPO |
$36.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.52
|
| Rate for Payer: EPIC Health Plan Senior |
$19.52
|
| Rate for Payer: Galaxy Health WC |
$41.47
|
| Rate for Payer: Global Benefits Group Commercial |
$29.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.15
|
| Rate for Payer: Multiplan Commercial |
$36.59
|
| Rate for Payer: Networks By Design Commercial |
$31.71
|
| Rate for Payer: Prime Health Services Commercial |
$41.47
|
| Rate for Payer: Riverside University Health System MISP |
$19.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.39
|
| Rate for Payer: United Healthcare All Other HMO |
$24.39
|
| Rate for Payer: United Healthcare HMO Rider |
$24.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.47
|
| Rate for Payer: Vantage Medical Group Senior |
$41.47
|
|
|
HC DRSNG SILVASORB SITE 1.75 HRTM
|
Facility
|
OP
|
$50.59
|
|
| Hospital Charge Code |
901692017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Adventist Health Commercial |
$10.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.43
|
| Rate for Payer: Blue Shield of California Commercial |
$32.07
|
| Rate for Payer: Blue Shield of California EPN |
$20.19
|
| Rate for Payer: Cash Price |
$22.77
|
| Rate for Payer: Central Health Plan Commercial |
$40.47
|
| Rate for Payer: Cigna of CA HMO |
$32.38
|
| Rate for Payer: Cigna of CA PPO |
$37.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$43.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.41
|
| Rate for Payer: Multiplan Commercial |
$37.94
|
| Rate for Payer: Networks By Design Commercial |
$32.88
|
| Rate for Payer: Prime Health Services Commercial |
$43.00
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.30
|
| Rate for Payer: United Healthcare All Other HMO |
$25.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.00
|
| Rate for Payer: Vantage Medical Group Senior |
$43.00
|
|
|
HC DRSNG SILVASORB SITE 1.75 HRTM
|
Facility
|
IP
|
$50.59
|
|
| Hospital Charge Code |
901692017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Adventist Health Commercial |
$10.12
|
| Rate for Payer: Cash Price |
$22.77
|
| Rate for Payer: Central Health Plan Commercial |
$40.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$43.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$37.94
|
| Rate for Payer: Networks By Design Commercial |
$32.88
|
| Rate for Payer: Prime Health Services Commercial |
$43.00
|
|
|
HC DRSNG SILVER RESTORE 6X8 IN
|
Facility
|
OP
|
$118.64
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Adventist Health Commercial |
$23.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.01
|
| Rate for Payer: Blue Shield of California Commercial |
$75.22
|
| Rate for Payer: Blue Shield of California EPN |
$47.34
|
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Central Health Plan Commercial |
$94.91
|
| Rate for Payer: Cigna of CA HMO |
$75.93
|
| Rate for Payer: Cigna of CA PPO |
$87.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$100.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.46
|
| Rate for Payer: EPIC Health Plan Senior |
$47.46
|
| Rate for Payer: Galaxy Health WC |
$100.84
|
| Rate for Payer: Global Benefits Group Commercial |
$71.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.05
|
| Rate for Payer: Multiplan Commercial |
$88.98
|
| Rate for Payer: Networks By Design Commercial |
$77.12
|
| Rate for Payer: Prime Health Services Commercial |
$100.84
|
| Rate for Payer: Riverside University Health System MISP |
$47.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.32
|
| Rate for Payer: United Healthcare All Other HMO |
$59.32
|
| Rate for Payer: United Healthcare HMO Rider |
$59.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.84
|
| Rate for Payer: Vantage Medical Group Senior |
$100.84
|
|
|
HC DRSNG SILVER RESTORE 6X8 IN
|
Facility
|
IP
|
$118.64
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.73 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Adventist Health Commercial |
$23.73
|
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Central Health Plan Commercial |
$94.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.46
|
| Rate for Payer: EPIC Health Plan Senior |
$47.46
|
| Rate for Payer: Galaxy Health WC |
$100.84
|
| Rate for Payer: Global Benefits Group Commercial |
$71.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.73
|
| Rate for Payer: Multiplan Commercial |
$88.98
|
| Rate for Payer: Networks By Design Commercial |
$77.12
|
| Rate for Payer: Prime Health Services Commercial |
$100.84
|
|
|
HC DRSNG SILVRCEL ALGINATE 1X12"
|
Facility
|
IP
|
$45.10
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Adventist Health Commercial |
$9.02
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: EPIC Health Plan Senior |
$18.04
|
| Rate for Payer: Galaxy Health WC |
$38.34
|
| Rate for Payer: Global Benefits Group Commercial |
$27.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$33.83
|
| Rate for Payer: Networks By Design Commercial |
$29.32
|
| Rate for Payer: Prime Health Services Commercial |
$38.34
|
|
|
HC DRSNG SILVRCEL ALGINATE 1X12"
|
Facility
|
OP
|
$45.10
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Adventist Health Commercial |
$9.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.23
|
| Rate for Payer: Blue Shield of California Commercial |
$28.59
|
| Rate for Payer: Blue Shield of California EPN |
$17.99
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.08
|
| Rate for Payer: Cigna of CA HMO |
$28.86
|
| Rate for Payer: Cigna of CA PPO |
$33.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: EPIC Health Plan Senior |
$18.04
|
| Rate for Payer: Galaxy Health WC |
$38.34
|
| Rate for Payer: Global Benefits Group Commercial |
$27.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.57
|
| Rate for Payer: Multiplan Commercial |
$33.83
|
| Rate for Payer: Networks By Design Commercial |
$29.32
|
| Rate for Payer: Prime Health Services Commercial |
$38.34
|
| Rate for Payer: Riverside University Health System MISP |
$18.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.55
|
| Rate for Payer: United Healthcare All Other HMO |
$22.55
|
| Rate for Payer: United Healthcare HMO Rider |
$22.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.34
|
| Rate for Payer: Vantage Medical Group Senior |
$38.34
|
|
|
HC DRSNG SLVR ALGINATE 4"X4.75"
|
Facility
|
OP
|
$44.03
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$41.35 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.61
|
| Rate for Payer: Blue Shield of California Commercial |
$27.92
|
| Rate for Payer: Blue Shield of California EPN |
$17.57
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$35.22
|
| Rate for Payer: Cigna of CA HMO |
$28.18
|
| Rate for Payer: Cigna of CA PPO |
$32.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.82
|
| Rate for Payer: Multiplan Commercial |
$33.02
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
| Rate for Payer: Riverside University Health System MISP |
$17.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.02
|
| Rate for Payer: United Healthcare All Other HMO |
$22.02
|
| Rate for Payer: United Healthcare HMO Rider |
$22.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.43
|
| Rate for Payer: Vantage Medical Group Senior |
$37.43
|
|
|
HC DRSNG SLVR ALGINATE 4"X4.75"
|
Facility
|
IP
|
$44.03
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$35.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$33.02
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
|
|
HC DRSNG SLVR AQUACEL AG 3.5X8"
|
Facility
|
OP
|
$251.93
|
|
| Hospital Charge Code |
901698804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$226.74 |
| Rate for Payer: Adventist Health Commercial |
$50.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.55
|
| Rate for Payer: Blue Shield of California Commercial |
$159.72
|
| Rate for Payer: Blue Shield of California EPN |
$100.52
|
| Rate for Payer: Cash Price |
$113.37
|
| Rate for Payer: Central Health Plan Commercial |
$201.54
|
| Rate for Payer: Cigna of CA HMO |
$161.24
|
| Rate for Payer: Cigna of CA PPO |
$186.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.77
|
| Rate for Payer: EPIC Health Plan Senior |
$100.77
|
| Rate for Payer: Galaxy Health WC |
$214.14
|
| Rate for Payer: Global Benefits Group Commercial |
$151.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$176.35
|
| Rate for Payer: Multiplan Commercial |
$188.95
|
| Rate for Payer: Networks By Design Commercial |
$163.75
|
| Rate for Payer: Prime Health Services Commercial |
$214.14
|
| Rate for Payer: Riverside University Health System MISP |
$100.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.97
|
| Rate for Payer: United Healthcare All Other HMO |
$125.97
|
| Rate for Payer: United Healthcare HMO Rider |
$125.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.14
|
| Rate for Payer: Vantage Medical Group Senior |
$214.14
|
|
