|
HC DRSNG TRANSPARENT IV 3.5"X4.5"
|
Facility
|
IP
|
$8.12
|
|
| Hospital Charge Code |
901698830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Adventist Health Commercial |
$1.62
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Central Health Plan Commercial |
$6.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.25
|
| Rate for Payer: EPIC Health Plan Senior |
$3.25
|
| Rate for Payer: Galaxy Health WC |
$6.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Multiplan Commercial |
$6.09
|
| Rate for Payer: Networks By Design Commercial |
$5.28
|
| Rate for Payer: Prime Health Services Commercial |
$6.90
|
|
|
HC DRSNG TRANSPARENT IV 3.5"X4.5"
|
Facility
|
OP
|
$8.12
|
|
| Hospital Charge Code |
901698830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Adventist Health Commercial |
$1.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$5.15
|
| Rate for Payer: Blue Shield of California EPN |
$3.24
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Central Health Plan Commercial |
$6.50
|
| Rate for Payer: Cigna of CA HMO |
$5.20
|
| Rate for Payer: Cigna of CA PPO |
$6.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.25
|
| Rate for Payer: EPIC Health Plan Senior |
$3.25
|
| Rate for Payer: Galaxy Health WC |
$6.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.68
|
| Rate for Payer: Multiplan Commercial |
$6.09
|
| Rate for Payer: Networks By Design Commercial |
$5.28
|
| Rate for Payer: Prime Health Services Commercial |
$6.90
|
| Rate for Payer: Riverside University Health System MISP |
$3.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.06
|
| Rate for Payer: United Healthcare All Other HMO |
$4.06
|
| Rate for Payer: United Healthcare HMO Rider |
$4.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6.90
|
|
|
HC DRSNG TRANSPRNT HYDRO 4X4 PLUS
|
Facility
|
OP
|
$29.60
|
|
| Hospital Charge Code |
901698752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Adventist Health Commercial |
$5.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.22
|
| Rate for Payer: Blue Shield of California Commercial |
$18.77
|
| Rate for Payer: Blue Shield of California EPN |
$11.81
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Central Health Plan Commercial |
$23.68
|
| Rate for Payer: Cigna of CA HMO |
$18.94
|
| Rate for Payer: Cigna of CA PPO |
$21.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.84
|
| Rate for Payer: EPIC Health Plan Senior |
$11.84
|
| Rate for Payer: Galaxy Health WC |
$25.16
|
| Rate for Payer: Global Benefits Group Commercial |
$17.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.72
|
| Rate for Payer: Multiplan Commercial |
$22.20
|
| Rate for Payer: Networks By Design Commercial |
$19.24
|
| Rate for Payer: Prime Health Services Commercial |
$25.16
|
| Rate for Payer: Riverside University Health System MISP |
$11.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.80
|
| Rate for Payer: United Healthcare All Other HMO |
$14.80
|
| Rate for Payer: United Healthcare HMO Rider |
$14.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.16
|
| Rate for Payer: Vantage Medical Group Senior |
$25.16
|
|
|
HC DRSNG TRANSPRNT HYDRO 4X4 PLUS
|
Facility
|
IP
|
$29.60
|
|
| Hospital Charge Code |
901698752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Adventist Health Commercial |
$5.92
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Central Health Plan Commercial |
$23.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.84
|
| Rate for Payer: EPIC Health Plan Senior |
$11.84
|
| Rate for Payer: Galaxy Health WC |
$25.16
|
| Rate for Payer: Global Benefits Group Commercial |
$17.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.92
|
| Rate for Payer: Multiplan Commercial |
$22.20
|
| Rate for Payer: Networks By Design Commercial |
$19.24
|
| Rate for Payer: Prime Health Services Commercial |
$25.16
|
|
|
HC DRSNG TRANSPRNT HYDRO 4X4 THIN
|
Facility
|
OP
|
$25.83
|
|
| Hospital Charge Code |
901698751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.03
|
| Rate for Payer: Blue Shield of California Commercial |
$16.38
|
| Rate for Payer: Blue Shield of California EPN |
$10.31
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: Central Health Plan Commercial |
$20.66
|
| Rate for Payer: Cigna of CA HMO |
$16.53
|
| Rate for Payer: Cigna of CA PPO |
$19.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.33
|
| Rate for Payer: EPIC Health Plan Senior |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$21.96
|
| Rate for Payer: Global Benefits Group Commercial |
$15.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.08
|
| Rate for Payer: Multiplan Commercial |
$19.37
|
| Rate for Payer: Networks By Design Commercial |
$16.79
|
| Rate for Payer: Prime Health Services Commercial |
$21.96
|
| Rate for Payer: Riverside University Health System MISP |
$10.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.91
|
| Rate for Payer: United Healthcare All Other HMO |
$12.91
|
| Rate for Payer: United Healthcare HMO Rider |
$12.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.96
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC DRSNG TRANSPRNT HYDRO 4X4 THIN
|
Facility
|
IP
|
$25.83
|
|
| Hospital Charge Code |
901698751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: Central Health Plan Commercial |
$20.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.33
|
| Rate for Payer: EPIC Health Plan Senior |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$21.96
|
| Rate for Payer: Global Benefits Group Commercial |
$15.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$19.37
|
| Rate for Payer: Networks By Design Commercial |
$16.79
|
| Rate for Payer: Prime Health Services Commercial |
$21.96
|
|
|
HC DRSNG TRNSPRNT 2.75X3.2 HRMT
|
Facility
|
IP
|
$3.60
|
|
| Hospital Charge Code |
901692016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
|
|
HC DRSNG TRNSPRNT 2.75X3.2 HRMT
|
Facility
|
OP
|
$3.60
|
|
| Hospital Charge Code |
901692016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.09
|
| Rate for Payer: Blue Shield of California Commercial |
$2.28
|
| Rate for Payer: Blue Shield of California EPN |
$1.44
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$2.30
|
| Rate for Payer: Cigna of CA PPO |
$2.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.06
|
| Rate for Payer: Global Benefits Group Commercial |
$2.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$2.70
|
| Rate for Payer: Networks By Design Commercial |
$2.34
|
| Rate for Payer: Prime Health Services Commercial |
$3.06
|
| Rate for Payer: Riverside University Health System MISP |
$1.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.06
|
| Rate for Payer: Vantage Medical Group Senior |
$3.06
|
|
|
HC DRSNG VAC ACTICOAT FLEX 3 4X4
|
Facility
|
OP
|
$102.60
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Adventist Health Commercial |
$20.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.68
|
| Rate for Payer: Blue Shield of California Commercial |
$65.05
|
| Rate for Payer: Blue Shield of California EPN |
$40.94
|
| Rate for Payer: Cash Price |
$46.17
|
| Rate for Payer: Cash Price |
$46.17
|
| Rate for Payer: Central Health Plan Commercial |
$82.08
|
| Rate for Payer: Cigna of CA HMO |
$65.66
|
| Rate for Payer: Cigna of CA PPO |
$75.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$87.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.04
|
| Rate for Payer: EPIC Health Plan Senior |
$41.04
|
| Rate for Payer: Galaxy Health WC |
$87.21
|
| Rate for Payer: Global Benefits Group Commercial |
$61.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$71.82
|
| Rate for Payer: Multiplan Commercial |
$76.95
|
| Rate for Payer: Networks By Design Commercial |
$66.69
|
| Rate for Payer: Prime Health Services Commercial |
$87.21
|
| Rate for Payer: Riverside University Health System MISP |
$41.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.30
|
| Rate for Payer: United Healthcare All Other HMO |
$51.30
|
| Rate for Payer: United Healthcare HMO Rider |
$51.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.21
|
| Rate for Payer: Vantage Medical Group Senior |
$87.21
|
|
|
HC DRSNG VAC ACTICOAT FLEX 3 4X4
|
Facility
|
IP
|
$102.60
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Adventist Health Commercial |
$20.52
|
| Rate for Payer: Cash Price |
$46.17
|
| Rate for Payer: Central Health Plan Commercial |
$82.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.04
|
| Rate for Payer: EPIC Health Plan Senior |
$41.04
|
| Rate for Payer: Galaxy Health WC |
$87.21
|
| Rate for Payer: Global Benefits Group Commercial |
$61.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.52
|
| Rate for Payer: Multiplan Commercial |
$76.95
|
| Rate for Payer: Networks By Design Commercial |
$66.69
|
| Rate for Payer: Prime Health Services Commercial |
$87.21
|
|
|
HC DRSNG VAC GAUZE ROLL LRG ANTIM
|
Facility
|
OP
|
$60.76
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$59.52 |
| Rate for Payer: Adventist Health Commercial |
$12.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.34
|
| Rate for Payer: Blue Shield of California Commercial |
$38.52
|
| Rate for Payer: Blue Shield of California EPN |
$24.24
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Central Health Plan Commercial |
$48.61
|
| Rate for Payer: Cigna of CA HMO |
$38.89
|
| Rate for Payer: Cigna of CA PPO |
$44.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Senior |
$24.30
|
| Rate for Payer: Galaxy Health WC |
$51.65
|
| Rate for Payer: Global Benefits Group Commercial |
$36.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.53
|
| Rate for Payer: Multiplan Commercial |
$45.57
|
| Rate for Payer: Networks By Design Commercial |
$39.49
|
| Rate for Payer: Prime Health Services Commercial |
$51.65
|
| Rate for Payer: Riverside University Health System MISP |
$24.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.38
|
| Rate for Payer: United Healthcare All Other HMO |
$30.38
|
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.65
|
| Rate for Payer: Vantage Medical Group Senior |
$51.65
|
|
|
HC DRSNG VAC GAUZE ROLL LRG ANTIM
|
Facility
|
IP
|
$60.76
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$54.68 |
| Rate for Payer: Adventist Health Commercial |
$12.15
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Central Health Plan Commercial |
$48.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Senior |
$24.30
|
| Rate for Payer: Galaxy Health WC |
$51.65
|
| Rate for Payer: Global Benefits Group Commercial |
$36.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.15
|
| Rate for Payer: Multiplan Commercial |
$45.57
|
| Rate for Payer: Networks By Design Commercial |
$39.49
|
| Rate for Payer: Prime Health Services Commercial |
$51.65
|
|
|
HC DRSNG VAC RESTORE AG 4X5
|
Facility
|
IP
|
$62.73
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901606110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$56.46 |
| Rate for Payer: Adventist Health Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Central Health Plan Commercial |
$50.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.09
|
| Rate for Payer: EPIC Health Plan Senior |
$25.09
|
| Rate for Payer: Galaxy Health WC |
$53.32
|
| Rate for Payer: Global Benefits Group Commercial |
$37.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$47.05
|
| Rate for Payer: Networks By Design Commercial |
$40.77
|
| Rate for Payer: Prime Health Services Commercial |
$53.32
|
|
|
HC DRSNG VAC RESTORE AG 4X5
|
Facility
|
OP
|
$62.73
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901606110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$56.46 |
| Rate for Payer: Adventist Health Commercial |
$12.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.49
|
| Rate for Payer: Blue Shield of California Commercial |
$39.77
|
| Rate for Payer: Blue Shield of California EPN |
$25.03
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Central Health Plan Commercial |
$50.18
|
| Rate for Payer: Cigna of CA HMO |
$40.15
|
| Rate for Payer: Cigna of CA PPO |
$46.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.09
|
| Rate for Payer: EPIC Health Plan Senior |
$25.09
|
| Rate for Payer: Galaxy Health WC |
$53.32
|
| Rate for Payer: Global Benefits Group Commercial |
$37.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.91
|
| Rate for Payer: Multiplan Commercial |
$47.05
|
| Rate for Payer: Networks By Design Commercial |
$40.77
|
| Rate for Payer: Prime Health Services Commercial |
$53.32
|
| Rate for Payer: Riverside University Health System MISP |
$25.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.36
|
| Rate for Payer: United Healthcare All Other HMO |
$31.36
|
| Rate for Payer: United Healthcare HMO Rider |
$31.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.32
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
|
|
HC DRSNG VAC VERAFLO CLEANSE MED
|
Facility
|
IP
|
$633.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.71 |
| Max. Negotiated Rate |
$570.20 |
| Rate for Payer: Adventist Health Commercial |
$126.71
|
| Rate for Payer: Cash Price |
$285.10
|
| Rate for Payer: Central Health Plan Commercial |
$506.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.42
|
| Rate for Payer: EPIC Health Plan Senior |
$253.42
|
| Rate for Payer: Galaxy Health WC |
$538.53
|
| Rate for Payer: Global Benefits Group Commercial |
$380.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.71
|
| Rate for Payer: Multiplan Commercial |
$475.17
|
| Rate for Payer: Networks By Design Commercial |
$411.81
|
| Rate for Payer: Prime Health Services Commercial |
$538.53
|
|
|
HC DRSNG VAC VERAFLO CLEANSE MED
|
Facility
|
OP
|
$633.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$570.20 |
| Rate for Payer: Adventist Health Commercial |
$126.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$475.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$306.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$368.54
|
| Rate for Payer: Blue Shield of California Commercial |
$401.68
|
| Rate for Payer: Blue Shield of California EPN |
$252.79
|
| Rate for Payer: Cash Price |
$285.10
|
| Rate for Payer: Cash Price |
$285.10
|
| Rate for Payer: Central Health Plan Commercial |
$506.85
|
| Rate for Payer: Cigna of CA HMO |
$405.48
|
| Rate for Payer: Cigna of CA PPO |
$468.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.42
|
| Rate for Payer: EPIC Health Plan Senior |
$253.42
|
| Rate for Payer: Galaxy Health WC |
$538.53
|
| Rate for Payer: Global Benefits Group Commercial |
$380.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$570.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$443.49
|
| Rate for Payer: Multiplan Commercial |
$475.17
|
| Rate for Payer: Networks By Design Commercial |
$411.81
|
| Rate for Payer: Prime Health Services Commercial |
$538.53
|
| Rate for Payer: Riverside University Health System MISP |
$253.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.78
|
| Rate for Payer: United Healthcare All Other HMO |
$316.78
|
| Rate for Payer: United Healthcare HMO Rider |
$316.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$316.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$538.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.53
|
| Rate for Payer: Vantage Medical Group Senior |
$538.53
|
|
|
HC DRSNG WND ADHESV RENASYS GEL P
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.33
|
| Rate for Payer: Blue Shield of California Commercial |
$26.51
|
| Rate for Payer: Blue Shield of California EPN |
$16.69
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Central Health Plan Commercial |
$33.46
|
| Rate for Payer: Cigna of CA HMO |
$26.76
|
| Rate for Payer: Cigna of CA PPO |
$30.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.73
|
| Rate for Payer: Galaxy Health WC |
$35.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.27
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.55
|
| Rate for Payer: Riverside University Health System MISP |
$16.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.55
|
| Rate for Payer: Vantage Medical Group Senior |
$35.55
|
|
|
HC DRSNG WND ADHESV RENASYS GEL P
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Central Health Plan Commercial |
$33.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.73
|
| Rate for Payer: Galaxy Health WC |
$35.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.36
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.55
|
|
|
HC DRSNG WOUND 3.6 X 8" MEDPORE
|
Facility
|
IP
|
$7.79
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901698618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Central Health Plan Commercial |
$6.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
|
|
HC DRSNG WOUND 3.6 X 8" MEDPORE
|
Facility
|
OP
|
$7.79
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901698618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4.94
|
| Rate for Payer: Blue Shield of California EPN |
$3.11
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Central Health Plan Commercial |
$6.23
|
| Rate for Payer: Cigna of CA HMO |
$4.99
|
| Rate for Payer: Cigna of CA PPO |
$5.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.45
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
| Rate for Payer: Riverside University Health System MISP |
$3.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.62
|
| Rate for Payer: Vantage Medical Group Senior |
$6.62
|
|
|
HC DRSNG WOUND ANASEPT GEL 3OZ
|
Facility
|
IP
|
$156.03
|
|
| Hospital Charge Code |
901698215
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$140.43 |
| Rate for Payer: Adventist Health Commercial |
$31.21
|
| Rate for Payer: Cash Price |
$70.21
|
| Rate for Payer: Central Health Plan Commercial |
$124.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.41
|
| Rate for Payer: EPIC Health Plan Senior |
$62.41
|
| Rate for Payer: Galaxy Health WC |
$132.63
|
| Rate for Payer: Global Benefits Group Commercial |
$93.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.21
|
| Rate for Payer: Multiplan Commercial |
$117.02
|
| Rate for Payer: Networks By Design Commercial |
$101.42
|
| Rate for Payer: Prime Health Services Commercial |
$132.63
|
|
|
HC DRSNG WOUND ANASEPT GEL 3OZ
|
Facility
|
OP
|
$156.03
|
|
| Hospital Charge Code |
901698215
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$140.43 |
| Rate for Payer: Adventist Health Commercial |
$31.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.76
|
| Rate for Payer: Blue Shield of California Commercial |
$98.92
|
| Rate for Payer: Blue Shield of California EPN |
$62.26
|
| Rate for Payer: Cash Price |
$70.21
|
| Rate for Payer: Central Health Plan Commercial |
$124.82
|
| Rate for Payer: Cigna of CA HMO |
$99.86
|
| Rate for Payer: Cigna of CA PPO |
$115.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.41
|
| Rate for Payer: EPIC Health Plan Senior |
$62.41
|
| Rate for Payer: Galaxy Health WC |
$132.63
|
| Rate for Payer: Global Benefits Group Commercial |
$93.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.22
|
| Rate for Payer: Multiplan Commercial |
$117.02
|
| Rate for Payer: Networks By Design Commercial |
$101.42
|
| Rate for Payer: Prime Health Services Commercial |
$132.63
|
| Rate for Payer: Riverside University Health System MISP |
$62.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.02
|
| Rate for Payer: United Healthcare All Other HMO |
$78.02
|
| Rate for Payer: United Healthcare HMO Rider |
$78.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.63
|
| Rate for Payer: Vantage Medical Group Senior |
$132.63
|
|
|
HC DRSNG WOUND BIOPATCH 2CM/4MM
|
Facility
|
OP
|
$54.53
|
|
| Hospital Charge Code |
901605126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$49.08 |
| Rate for Payer: Adventist Health Commercial |
$10.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.72
|
| Rate for Payer: Blue Shield of California Commercial |
$34.57
|
| Rate for Payer: Blue Shield of California EPN |
$21.76
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Central Health Plan Commercial |
$43.62
|
| Rate for Payer: Cigna of CA HMO |
$34.90
|
| Rate for Payer: Cigna of CA PPO |
$40.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.81
|
| Rate for Payer: EPIC Health Plan Senior |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$46.35
|
| Rate for Payer: Global Benefits Group Commercial |
$32.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38.17
|
| Rate for Payer: Multiplan Commercial |
$40.90
|
| Rate for Payer: Networks By Design Commercial |
$35.44
|
| Rate for Payer: Prime Health Services Commercial |
$46.35
|
| Rate for Payer: Riverside University Health System MISP |
$21.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.27
|
| Rate for Payer: United Healthcare All Other HMO |
$27.27
|
| Rate for Payer: United Healthcare HMO Rider |
$27.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.35
|
| Rate for Payer: Vantage Medical Group Senior |
$46.35
|
|
|
HC DRSNG WOUND BIOPATCH 2CM/4MM
|
Facility
|
IP
|
$54.53
|
|
| Hospital Charge Code |
901605126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$49.08 |
| Rate for Payer: Adventist Health Commercial |
$10.91
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Central Health Plan Commercial |
$43.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.81
|
| Rate for Payer: EPIC Health Plan Senior |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$46.35
|
| Rate for Payer: Global Benefits Group Commercial |
$32.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$40.90
|
| Rate for Payer: Networks By Design Commercial |
$35.44
|
| Rate for Payer: Prime Health Services Commercial |
$46.35
|
|
|
HC DRSNG WOUND DURAFIBER AG 4X4
|
Facility
|
IP
|
$61.66
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Adventist Health Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Central Health Plan Commercial |
$49.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.66
|
| Rate for Payer: EPIC Health Plan Senior |
$24.66
|
| Rate for Payer: Galaxy Health WC |
$52.41
|
| Rate for Payer: Global Benefits Group Commercial |
$37.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.33
|
| Rate for Payer: Multiplan Commercial |
$46.24
|
| Rate for Payer: Networks By Design Commercial |
$40.08
|
| Rate for Payer: Prime Health Services Commercial |
$52.41
|
|
