|
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
|
|
|
HC DRSNG WOUND ES PLUS AG RIBBON
|
Facility
|
IP
|
$74.78
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901698127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$67.30 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Central Health Plan Commercial |
$59.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Multiplan Commercial |
$56.09
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
|
|
HC DRSNG WOUND ES PLUS AG RIBBON
|
Facility
|
OP
|
$74.78
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901698127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$67.30 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.50
|
| Rate for Payer: Blue Shield of California Commercial |
$47.41
|
| Rate for Payer: Blue Shield of California EPN |
$29.84
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Central Health Plan Commercial |
$59.82
|
| Rate for Payer: Cigna of CA HMO |
$47.86
|
| Rate for Payer: Cigna of CA PPO |
$55.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52.35
|
| Rate for Payer: Multiplan Commercial |
$56.09
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
| Rate for Payer: Riverside University Health System MISP |
$29.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.39
|
| Rate for Payer: United Healthcare All Other HMO |
$37.39
|
| Rate for Payer: United Healthcare HMO Rider |
$37.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.56
|
| Rate for Payer: Vantage Medical Group Senior |
$63.56
|
|
|
HC DRSNG WOUND GAUZE ADH 4X14"
|
Facility
|
OP
|
$6.97
|
|
| Hospital Charge Code |
901698919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Central Health Plan Commercial |
$5.58
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$5.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$5.23
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
| Rate for Payer: Riverside University Health System MISP |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.92
|
| Rate for Payer: Vantage Medical Group Senior |
$5.92
|
|
|
HC DRSNG WOUND GAUZE ADH 4X14"
|
Facility
|
IP
|
$6.97
|
|
| Hospital Charge Code |
901698919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Central Health Plan Commercial |
$5.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$5.23
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
|
|
HC DRSNG WOUND INTERDRY
|
Facility
|
IP
|
$338.45
|
|
| Hospital Charge Code |
901605294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$304.61 |
| Rate for Payer: Adventist Health Commercial |
$67.69
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Central Health Plan Commercial |
$270.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$236.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.38
|
| Rate for Payer: EPIC Health Plan Senior |
$135.38
|
| Rate for Payer: Galaxy Health WC |
$287.68
|
| Rate for Payer: Global Benefits Group Commercial |
$203.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$304.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.69
|
| Rate for Payer: Multiplan Commercial |
$253.84
|
| Rate for Payer: Networks By Design Commercial |
$219.99
|
| Rate for Payer: Prime Health Services Commercial |
$287.68
|
|
|
HC DRSNG WOUND INTERDRY
|
Facility
|
OP
|
$338.45
|
|
| Hospital Charge Code |
901605294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$304.61 |
| Rate for Payer: Adventist Health Commercial |
$67.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$205.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$287.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$253.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$196.88
|
| Rate for Payer: Blue Shield of California Commercial |
$214.58
|
| Rate for Payer: Blue Shield of California EPN |
$135.04
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Central Health Plan Commercial |
$270.76
|
| Rate for Payer: Cigna of CA HMO |
$216.61
|
| Rate for Payer: Cigna of CA PPO |
$250.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$287.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$287.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$287.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$236.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.38
|
| Rate for Payer: EPIC Health Plan Senior |
$135.38
|
| Rate for Payer: Galaxy Health WC |
$287.68
|
| Rate for Payer: Global Benefits Group Commercial |
$203.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$304.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$199.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$236.91
|
| Rate for Payer: Multiplan Commercial |
$253.84
|
| Rate for Payer: Networks By Design Commercial |
$219.99
|
| Rate for Payer: Prime Health Services Commercial |
$287.68
|
| Rate for Payer: Riverside University Health System MISP |
$135.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.22
|
| Rate for Payer: United Healthcare All Other HMO |
$169.22
|
| Rate for Payer: United Healthcare HMO Rider |
$169.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$169.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$287.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$287.68
|
| Rate for Payer: Vantage Medical Group Senior |
$287.68
|
|
|
HC DRSNG WOUND MEPILEX 8X8"
|
Facility
|
IP
|
$210.84
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901695705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$189.76 |
| Rate for Payer: Adventist Health Commercial |
$42.17
|
| Rate for Payer: Cash Price |
$94.88
|
| Rate for Payer: Central Health Plan Commercial |
$168.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.34
|
| Rate for Payer: EPIC Health Plan Senior |
$84.34
|
| Rate for Payer: Galaxy Health WC |
$179.21
|
| Rate for Payer: Global Benefits Group Commercial |
$126.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.17
|
| Rate for Payer: Multiplan Commercial |
$158.13
|
| Rate for Payer: Networks By Design Commercial |
$137.05
|
| Rate for Payer: Prime Health Services Commercial |
$179.21
|
|
|
HC DRSNG WOUND MEPILEX 8X8"
|
Facility
|
OP
|
$210.84
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901695705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$189.76 |
| Rate for Payer: Adventist Health Commercial |
$42.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.65
|
| Rate for Payer: Blue Shield of California Commercial |
$133.67
|
| Rate for Payer: Blue Shield of California EPN |
$84.13
|
| Rate for Payer: Cash Price |
$94.88
|
| Rate for Payer: Cash Price |
$94.88
|
| Rate for Payer: Central Health Plan Commercial |
$168.67
|
| Rate for Payer: Cigna of CA HMO |
$134.94
|
| Rate for Payer: Cigna of CA PPO |
$156.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$179.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$179.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.34
|
| Rate for Payer: EPIC Health Plan Senior |
$84.34
|
| Rate for Payer: Galaxy Health WC |
$179.21
|
| Rate for Payer: Global Benefits Group Commercial |
$126.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$124.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$147.59
|
| Rate for Payer: Multiplan Commercial |
$158.13
|
| Rate for Payer: Networks By Design Commercial |
$137.05
|
| Rate for Payer: Prime Health Services Commercial |
$179.21
|
| Rate for Payer: Riverside University Health System MISP |
$84.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.42
|
| Rate for Payer: United Healthcare All Other HMO |
$105.42
|
| Rate for Payer: United Healthcare HMO Rider |
$105.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$179.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$179.21
|
| Rate for Payer: Vantage Medical Group Senior |
$179.21
|
|
|
HC DRSNG WOUND MEPORE 3.5"X6"
|
Facility
|
IP
|
$3.12
|
|
| Hospital Charge Code |
901604798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Central Health Plan Commercial |
$2.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
|
|
HC DRSNG WOUND MEPORE 3.5"X6"
|
Facility
|
OP
|
$3.12
|
|
| Hospital Charge Code |
901604798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1.98
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Central Health Plan Commercial |
$2.50
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
| Rate for Payer: Riverside University Health System MISP |
$1.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2.65
|
|
|
HC DRSNG WOUND NON-ADHSV 6.125X8"
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901607859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$122.71 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$51.99
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRSNG WOUND NON-ADHSV 6.125X8"
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901607859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC DRSNG WOUND VAC ATS SMALL
|
Facility
|
OP
|
$225.96
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$203.36 |
| Rate for Payer: Adventist Health Commercial |
$45.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.44
|
| Rate for Payer: Blue Shield of California Commercial |
$143.26
|
| Rate for Payer: Blue Shield of California EPN |
$90.16
|
| Rate for Payer: Cash Price |
$101.68
|
| Rate for Payer: Cash Price |
$101.68
|
| Rate for Payer: Central Health Plan Commercial |
$180.77
|
| Rate for Payer: Cigna of CA HMO |
$144.61
|
| Rate for Payer: Cigna of CA PPO |
$167.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.38
|
| Rate for Payer: EPIC Health Plan Senior |
$90.38
|
| Rate for Payer: Galaxy Health WC |
$192.07
|
| Rate for Payer: Global Benefits Group Commercial |
$135.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$158.17
|
| Rate for Payer: Multiplan Commercial |
$169.47
|
| Rate for Payer: Networks By Design Commercial |
$146.87
|
| Rate for Payer: Prime Health Services Commercial |
$192.07
|
| Rate for Payer: Riverside University Health System MISP |
$90.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.98
|
| Rate for Payer: United Healthcare All Other HMO |
$112.98
|
| Rate for Payer: United Healthcare HMO Rider |
$112.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.07
|
| Rate for Payer: Vantage Medical Group Senior |
$192.07
|
|
|
HC DRSNG WOUND VAC ATS SMALL
|
Facility
|
IP
|
$225.96
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$203.36 |
| Rate for Payer: Adventist Health Commercial |
$45.19
|
| Rate for Payer: Cash Price |
$101.68
|
| Rate for Payer: Central Health Plan Commercial |
$180.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.38
|
| Rate for Payer: EPIC Health Plan Senior |
$90.38
|
| Rate for Payer: Galaxy Health WC |
$192.07
|
| Rate for Payer: Global Benefits Group Commercial |
$135.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.19
|
| Rate for Payer: Multiplan Commercial |
$169.47
|
| Rate for Payer: Networks By Design Commercial |
$146.87
|
| Rate for Payer: Prime Health Services Commercial |
$192.07
|
|
|
HC DRSNG WOUND VAC LG
|
Facility
|
IP
|
$343.77
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$309.39 |
| Rate for Payer: Adventist Health Commercial |
$68.75
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Central Health Plan Commercial |
$275.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$240.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.51
|
| Rate for Payer: EPIC Health Plan Senior |
$137.51
|
| Rate for Payer: Galaxy Health WC |
$292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$206.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$309.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$218.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.75
|
| Rate for Payer: Multiplan Commercial |
$257.83
|
| Rate for Payer: Networks By Design Commercial |
$223.45
|
| Rate for Payer: Prime Health Services Commercial |
$292.20
|
|
|
HC DRSNG WOUND VAC LG
|
Facility
|
OP
|
$343.77
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$309.39 |
| Rate for Payer: Adventist Health Commercial |
$68.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$189.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$257.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$166.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.97
|
| Rate for Payer: Blue Shield of California Commercial |
$217.95
|
| Rate for Payer: Blue Shield of California EPN |
$137.16
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Central Health Plan Commercial |
$275.02
|
| Rate for Payer: Cigna of CA HMO |
$220.01
|
| Rate for Payer: Cigna of CA PPO |
$254.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$292.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$292.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$240.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.51
|
| Rate for Payer: EPIC Health Plan Senior |
$137.51
|
| Rate for Payer: Galaxy Health WC |
$292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$206.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$309.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$218.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$240.64
|
| Rate for Payer: Multiplan Commercial |
$257.83
|
| Rate for Payer: Networks By Design Commercial |
$223.45
|
| Rate for Payer: Prime Health Services Commercial |
$292.20
|
| Rate for Payer: Riverside University Health System MISP |
$137.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$206.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$206.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.88
|
| Rate for Payer: United Healthcare All Other HMO |
$171.88
|
| Rate for Payer: United Healthcare HMO Rider |
$171.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$292.20
|
| Rate for Payer: Vantage Medical Group Senior |
$292.20
|
|
|
HC DRSNG WOUND VAC MED BLACK
|
Facility
|
IP
|
$279.16
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$251.24 |
| Rate for Payer: Adventist Health Commercial |
$55.83
|
| Rate for Payer: Cash Price |
$125.62
|
| Rate for Payer: Central Health Plan Commercial |
$223.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$195.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.66
|
| Rate for Payer: EPIC Health Plan Senior |
$111.66
|
| Rate for Payer: Galaxy Health WC |
$237.29
|
| Rate for Payer: Global Benefits Group Commercial |
$167.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$251.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.83
|
| Rate for Payer: Multiplan Commercial |
$209.37
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$237.29
|
|
|
HC DRSNG WOUND VAC MED BLACK
|
Facility
|
OP
|
$279.16
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$251.24 |
| Rate for Payer: Adventist Health Commercial |
$55.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$237.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.39
|
| Rate for Payer: Blue Shield of California Commercial |
$176.99
|
| Rate for Payer: Blue Shield of California EPN |
$111.38
|
| Rate for Payer: Cash Price |
$125.62
|
| Rate for Payer: Cash Price |
$125.62
|
| Rate for Payer: Central Health Plan Commercial |
$223.33
|
| Rate for Payer: Cigna of CA HMO |
$178.66
|
| Rate for Payer: Cigna of CA PPO |
$206.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$237.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$237.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$237.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$195.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.66
|
| Rate for Payer: EPIC Health Plan Senior |
$111.66
|
| Rate for Payer: Galaxy Health WC |
$237.29
|
| Rate for Payer: Global Benefits Group Commercial |
$167.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$251.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$195.41
|
| Rate for Payer: Multiplan Commercial |
$209.37
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$237.29
|
| Rate for Payer: Riverside University Health System MISP |
$111.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$167.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$167.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.58
|
| Rate for Payer: United Healthcare All Other HMO |
$139.58
|
| Rate for Payer: United Healthcare HMO Rider |
$139.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$237.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$237.29
|
| Rate for Payer: Vantage Medical Group Senior |
$237.29
|
|
|
HC DRSNG WOUND VAC MED SLVR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901609001
|
|
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 WOUND VAC MED SLVR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901609001
|
|
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 WOUND VAC THIN
|
Facility
|
OP
|
$364.82
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$328.34 |
| Rate for Payer: Adventist Health Commercial |
$72.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$176.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.22
|
| Rate for Payer: Blue Shield of California Commercial |
$231.30
|
| Rate for Payer: Blue Shield of California EPN |
$145.56
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Central Health Plan Commercial |
$291.86
|
| Rate for Payer: Cigna of CA HMO |
$233.48
|
| Rate for Payer: Cigna of CA PPO |
$269.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$310.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.93
|
| Rate for Payer: EPIC Health Plan Senior |
$145.93
|
| Rate for Payer: Galaxy Health WC |
$310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$218.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$255.37
|
| Rate for Payer: Multiplan Commercial |
$273.62
|
| Rate for Payer: Networks By Design Commercial |
$237.13
|
| Rate for Payer: Prime Health Services Commercial |
$310.10
|
| Rate for Payer: Riverside University Health System MISP |
$145.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.41
|
| Rate for Payer: United Healthcare All Other HMO |
$182.41
|
| Rate for Payer: United Healthcare HMO Rider |
$182.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$182.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.10
|
| Rate for Payer: Vantage Medical Group Senior |
$310.10
|
|
|
HC DRSNG WOUND VAC THIN
|
Facility
|
IP
|
$364.82
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$328.34 |
| Rate for Payer: Adventist Health Commercial |
$72.96
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Central Health Plan Commercial |
$291.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.93
|
| Rate for Payer: EPIC Health Plan Senior |
$145.93
|
| Rate for Payer: Galaxy Health WC |
$310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$218.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.96
|
| Rate for Payer: Multiplan Commercial |
$273.62
|
| Rate for Payer: Networks By Design Commercial |
$237.13
|
| Rate for Payer: Prime Health Services Commercial |
$310.10
|
|
|
HC DRSNG WOUND VAC THIN FOAM
|
Facility
|
IP
|
$294.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.91 |
| Max. Negotiated Rate |
$265.10 |
| Rate for Payer: Adventist Health Commercial |
$58.91
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Central Health Plan Commercial |
$235.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.82
|
| Rate for Payer: EPIC Health Plan Senior |
$117.82
|
| Rate for Payer: Galaxy Health WC |
$250.38
|
| Rate for Payer: Global Benefits Group Commercial |
$176.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$265.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.91
|
| Rate for Payer: Multiplan Commercial |
$220.92
|
| Rate for Payer: Networks By Design Commercial |
$191.46
|
| Rate for Payer: Prime Health Services Commercial |
$250.38
|
|
|
HC DRSNG WOUND VAC THIN FOAM
|
Facility
|
OP
|
$294.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$265.10 |
| Rate for Payer: Adventist Health Commercial |
$58.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$250.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.35
|
| Rate for Payer: Blue Shield of California Commercial |
$186.75
|
| Rate for Payer: Blue Shield of California EPN |
$117.53
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Central Health Plan Commercial |
$235.65
|
| Rate for Payer: Cigna of CA HMO |
$188.52
|
| Rate for Payer: Cigna of CA PPO |
$217.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$250.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$250.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.82
|
| Rate for Payer: EPIC Health Plan Senior |
$117.82
|
| Rate for Payer: Galaxy Health WC |
$250.38
|
| Rate for Payer: Global Benefits Group Commercial |
$176.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$265.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$206.19
|
| Rate for Payer: Multiplan Commercial |
$220.92
|
| Rate for Payer: Networks By Design Commercial |
$191.46
|
| Rate for Payer: Prime Health Services Commercial |
$250.38
|
| Rate for Payer: Riverside University Health System MISP |
$117.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$147.28
|
| Rate for Payer: United Healthcare All Other HMO |
$147.28
|
| Rate for Payer: United Healthcare HMO Rider |
$147.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$250.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.38
|
| Rate for Payer: Vantage Medical Group Senior |
$250.38
|
|
