|
HC DRSG IV ADV CNTL LNE 4X4 3/4IN
|
Facility
|
OP
|
$8.04
|
|
| Hospital Charge Code |
901606218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.91
|
| Rate for Payer: Blue Shield of California EPN |
$3.21
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Central Health Plan Commercial |
$6.43
|
| Rate for Payer: Cigna of CA HMO |
$5.15
|
| Rate for Payer: Cigna of CA PPO |
$5.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Senior |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.24
|
| Rate for Payer: InnovAge PACE Commercial |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.63
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
| Rate for Payer: Riverside University Health System MISP |
$3.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.02
|
| Rate for Payer: United Healthcare All Other HMO |
$4.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Vantage Medical Group Senior |
$6.83
|
|
|
HC DRSG IV ADV CNTL LNE 4X4 3/4IN
|
Facility
|
IP
|
$8.04
|
|
| Hospital Charge Code |
901606218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Central Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Senior |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
|
|
HC DRSG POLY 3.5X3.5 NON-ADH FOAM
|
Facility
|
IP
|
$22.22
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Adventist Health Commercial |
$4.44
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$17.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.89
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$18.89
|
| Rate for Payer: Global Benefits Group Commercial |
$13.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Networks By Design Commercial |
$14.44
|
| Rate for Payer: Prime Health Services Commercial |
$18.89
|
|
|
HC DRSG POLY 3.5X3.5 NON-ADH FOAM
|
Facility
|
OP
|
$22.22
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Adventist Health Commercial |
$4.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.05
|
| Rate for Payer: Blue Shield of California Commercial |
$13.58
|
| Rate for Payer: Blue Shield of California EPN |
$8.87
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$17.78
|
| Rate for Payer: Cigna of CA HMO |
$14.22
|
| Rate for Payer: Cigna of CA PPO |
$16.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.89
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$18.89
|
| Rate for Payer: Global Benefits Group Commercial |
$13.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.00
|
| Rate for Payer: InnovAge PACE Commercial |
$11.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.55
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Networks By Design Commercial |
$14.44
|
| Rate for Payer: Prime Health Services Commercial |
$18.89
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| Rate for Payer: United Healthcare All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.89
|
| Rate for Payer: Vantage Medical Group Senior |
$18.89
|
|
|
HC DRSG WOUND ADH 4X10 W/2X8" PAD
|
Facility
|
OP
|
$5.90
|
|
| Hospital Charge Code |
901698914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.47
|
| Rate for Payer: Blue Shield of California Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.35
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Central Health Plan Commercial |
$4.72
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.31
|
| Rate for Payer: InnovAge PACE Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Riverside University Health System MISP |
$2.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
HC DRSG WOUND ADH 4X10 W/2X8" PAD
|
Facility
|
IP
|
$5.90
|
|
| Hospital Charge Code |
901698914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Central Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
|
|
HC DRSNG ABD ABTHERA SENSATR
|
Facility
|
IP
|
$2,200.64
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.13 |
| Max. Negotiated Rate |
$1,980.58 |
| Rate for Payer: Adventist Health Commercial |
$440.13
|
| Rate for Payer: Cash Price |
$990.29
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.26
|
| Rate for Payer: EPIC Health Plan Senior |
$880.26
|
| Rate for Payer: Galaxy Health WC |
$1,870.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.13
|
| Rate for Payer: Multiplan Commercial |
$1,650.48
|
| Rate for Payer: Networks By Design Commercial |
$1,430.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.54
|
|
|
HC DRSNG ABD ABTHERA SENSATR
|
Facility
|
OP
|
$2,200.64
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$1,980.58 |
| Rate for Payer: Adventist Health Commercial |
$440.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,336.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,065.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,292.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,344.59
|
| Rate for Payer: Blue Shield of California EPN |
$878.06
|
| Rate for Payer: Cash Price |
$990.29
|
| Rate for Payer: Cash Price |
$990.29
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.51
|
| Rate for Payer: Cigna of CA HMO |
$1,408.41
|
| Rate for Payer: Cigna of CA PPO |
$1,628.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.26
|
| Rate for Payer: EPIC Health Plan Senior |
$880.26
|
| Rate for Payer: Galaxy Health WC |
$1,870.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$1,100.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.45
|
| Rate for Payer: Multiplan Commercial |
$1,650.48
|
| Rate for Payer: Networks By Design Commercial |
$1,430.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.54
|
| Rate for Payer: Riverside University Health System MISP |
$880.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,100.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,100.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,100.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,100.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.54
|
|
|
HC DRSNG ABD PAD 8X10IN SINGLE
|
Facility
|
OP
|
$4.18
|
|
| Hospital Charge Code |
901698911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Central Health Plan Commercial |
$3.34
|
| Rate for Payer: Cigna of CA HMO |
$2.68
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.67
|
| Rate for Payer: EPIC Health Plan Senior |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.76
|
| Rate for Payer: InnovAge PACE Commercial |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$3.13
|
| Rate for Payer: Networks By Design Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.55
|
| Rate for Payer: Riverside University Health System MISP |
$1.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.09
|
| Rate for Payer: United Healthcare All Other HMO |
$2.09
|
| Rate for Payer: United Healthcare HMO Rider |
$2.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3.55
|
|
|
HC DRSNG ABD PAD 8X10IN SINGLE
|
Facility
|
IP
|
$4.18
|
|
| Hospital Charge Code |
901698911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Central Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.67
|
| Rate for Payer: EPIC Health Plan Senior |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.13
|
| Rate for Payer: Networks By Design Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.55
|
|
|
HC DRSNG ABD PAD 8X10IN STRL
|
Facility
|
OP
|
$0.90
|
|
| Hospital Charge Code |
901698913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$0.58
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.81
|
| Rate for Payer: InnovAge PACE Commercial |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Riverside University Health System MISP |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
HC DRSNG ABD PAD 8X10IN STRL
|
Facility
|
IP
|
$0.90
|
|
| Hospital Charge Code |
901698913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
|
|
HC DRSNG ABSORB 8X20 MIPILEX
|
Facility
|
OP
|
$426.88
|
|
| Hospital Charge Code |
901696388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$384.19 |
| Rate for Payer: Adventist Health Commercial |
$85.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$259.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$206.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.71
|
| Rate for Payer: Blue Shield of California Commercial |
$260.82
|
| Rate for Payer: Blue Shield of California EPN |
$170.33
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Central Health Plan Commercial |
$341.50
|
| Rate for Payer: Cigna of CA HMO |
$273.20
|
| Rate for Payer: Cigna of CA PPO |
$315.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$362.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.75
|
| Rate for Payer: EPIC Health Plan Senior |
$170.75
|
| Rate for Payer: Galaxy Health WC |
$362.85
|
| Rate for Payer: Global Benefits Group Commercial |
$256.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.19
|
| Rate for Payer: InnovAge PACE Commercial |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$298.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$298.82
|
| Rate for Payer: Multiplan Commercial |
$320.16
|
| Rate for Payer: Networks By Design Commercial |
$277.47
|
| Rate for Payer: Prime Health Services Commercial |
$362.85
|
| Rate for Payer: Riverside University Health System MISP |
$170.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.44
|
| Rate for Payer: United Healthcare All Other HMO |
$213.44
|
| Rate for Payer: United Healthcare HMO Rider |
$213.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$362.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.85
|
| Rate for Payer: Vantage Medical Group Senior |
$362.85
|
|
|
HC DRSNG ABSORB 8X20 MIPILEX
|
Facility
|
IP
|
$426.88
|
|
| Hospital Charge Code |
901696388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$384.19 |
| Rate for Payer: Adventist Health Commercial |
$85.38
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Central Health Plan Commercial |
$341.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.75
|
| Rate for Payer: EPIC Health Plan Senior |
$170.75
|
| Rate for Payer: Galaxy Health WC |
$362.85
|
| Rate for Payer: Global Benefits Group Commercial |
$256.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.38
|
| Rate for Payer: Multiplan Commercial |
$320.16
|
| Rate for Payer: Networks By Design Commercial |
$277.47
|
| Rate for Payer: Prime Health Services Commercial |
$362.85
|
|
|
HC DRSNG ABSORBENT FOAM 4X4 MIPILEX
|
Facility
|
OP
|
$56.99
|
|
| Hospital Charge Code |
901696386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.29 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.47
|
| Rate for Payer: Blue Shield of California Commercial |
$34.82
|
| Rate for Payer: Blue Shield of California EPN |
$22.74
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.59
|
| Rate for Payer: Cigna of CA HMO |
$36.47
|
| Rate for Payer: Cigna of CA PPO |
$42.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.44
|
| Rate for Payer: Global Benefits Group Commercial |
$34.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.29
|
| Rate for Payer: InnovAge PACE Commercial |
$28.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.89
|
| Rate for Payer: Multiplan Commercial |
$42.74
|
| Rate for Payer: Networks By Design Commercial |
$37.04
|
| Rate for Payer: Prime Health Services Commercial |
$48.44
|
| Rate for Payer: Riverside University Health System MISP |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.44
|
| Rate for Payer: Vantage Medical Group Senior |
$48.44
|
|
|
HC DRSNG ABSORBENT FOAM 4X4 MIPILEX
|
Facility
|
IP
|
$56.99
|
|
| Hospital Charge Code |
901696386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.29 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.44
|
| Rate for Payer: Global Benefits Group Commercial |
$34.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Multiplan Commercial |
$42.74
|
| Rate for Payer: Networks By Design Commercial |
$37.04
|
| Rate for Payer: Prime Health Services Commercial |
$48.44
|
|
|
HC DRSNG ABSORBNT COMPOSITE 4X10
|
Facility
|
OP
|
$13.12
|
|
| Hospital Charge Code |
901698912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Blue Shield of California Commercial |
$8.02
|
| Rate for Payer: Blue Shield of California EPN |
$5.23
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Central Health Plan Commercial |
$10.50
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.81
|
| Rate for Payer: InnovAge PACE Commercial |
$6.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.18
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
| Rate for Payer: Riverside University Health System MISP |
$5.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.15
|
| Rate for Payer: Vantage Medical Group Senior |
$11.15
|
|
|
HC DRSNG ABSORBNT COMPOSITE 4X10
|
Facility
|
IP
|
$13.12
|
|
| Hospital Charge Code |
901698912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$5.90
|
| Rate for Payer: Central Health Plan Commercial |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$9.84
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
|
|
HC DRSNG ACTICOAT 4X10 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$210.77
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$189.69 |
| Rate for Payer: Adventist Health Commercial |
$42.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.79
|
| Rate for Payer: Blue Shield of California Commercial |
$128.78
|
| Rate for Payer: Blue Shield of California EPN |
$84.10
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Central Health Plan Commercial |
$168.62
|
| Rate for Payer: Cigna of CA HMO |
$134.89
|
| Rate for Payer: Cigna of CA PPO |
$155.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$179.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$179.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.31
|
| Rate for Payer: EPIC Health Plan Senior |
$84.31
|
| Rate for Payer: Galaxy Health WC |
$179.15
|
| Rate for Payer: Global Benefits Group Commercial |
$126.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.69
|
| Rate for Payer: InnovAge PACE Commercial |
$105.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.54
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Networks By Design Commercial |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$179.15
|
| Rate for Payer: Riverside University Health System MISP |
$84.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.39
|
| Rate for Payer: United Healthcare All Other HMO |
$105.39
|
| Rate for Payer: United Healthcare HMO Rider |
$105.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$179.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$179.15
|
| Rate for Payer: Vantage Medical Group Senior |
$179.15
|
|
|
HC DRSNG ACTICOAT 4X10 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$210.77
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$189.69 |
| Rate for Payer: Adventist Health Commercial |
$42.15
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Central Health Plan Commercial |
$168.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.31
|
| Rate for Payer: EPIC Health Plan Senior |
$84.31
|
| Rate for Payer: Galaxy Health WC |
$179.15
|
| Rate for Payer: Global Benefits Group Commercial |
$126.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$130.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.15
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Networks By Design Commercial |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$179.15
|
|
|
HC DRSNG ACTICOAT 4X13 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$289.38
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901606857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$260.44 |
| Rate for Payer: Adventist Health Commercial |
$57.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.95
|
| Rate for Payer: Blue Shield of California Commercial |
$176.81
|
| Rate for Payer: Blue Shield of California EPN |
$115.46
|
| Rate for Payer: Cash Price |
$130.22
|
| Rate for Payer: Central Health Plan Commercial |
$231.50
|
| Rate for Payer: Cigna of CA HMO |
$185.20
|
| Rate for Payer: Cigna of CA PPO |
$214.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$245.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$245.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.75
|
| Rate for Payer: EPIC Health Plan Senior |
$115.75
|
| Rate for Payer: Galaxy Health WC |
$245.97
|
| Rate for Payer: Global Benefits Group Commercial |
$173.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.44
|
| Rate for Payer: InnovAge PACE Commercial |
$144.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$202.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$202.57
|
| Rate for Payer: Multiplan Commercial |
$217.03
|
| Rate for Payer: Networks By Design Commercial |
$188.10
|
| Rate for Payer: Prime Health Services Commercial |
$245.97
|
| Rate for Payer: Riverside University Health System MISP |
$115.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$173.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.69
|
| Rate for Payer: United Healthcare All Other HMO |
$144.69
|
| Rate for Payer: United Healthcare HMO Rider |
$144.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$245.97
|
| Rate for Payer: Vantage Medical Group Senior |
$245.97
|
|
|
HC DRSNG ACTICOAT 4X13 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$289.38
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901606857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$260.44 |
| Rate for Payer: Adventist Health Commercial |
$57.88
|
| Rate for Payer: Cash Price |
$130.22
|
| Rate for Payer: Central Health Plan Commercial |
$231.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.75
|
| Rate for Payer: EPIC Health Plan Senior |
$115.75
|
| Rate for Payer: Galaxy Health WC |
$245.97
|
| Rate for Payer: Global Benefits Group Commercial |
$173.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.88
|
| Rate for Payer: Multiplan Commercial |
$217.03
|
| Rate for Payer: Networks By Design Commercial |
$188.10
|
| Rate for Payer: Prime Health Services Commercial |
$245.97
|
|
|
HC DRSNG ACTICOAT 4X4 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$133.91
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Adventist Health Commercial |
$26.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.65
|
| Rate for Payer: Blue Shield of California Commercial |
$81.82
|
| Rate for Payer: Blue Shield of California EPN |
$53.43
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Central Health Plan Commercial |
$107.13
|
| Rate for Payer: Cigna of CA HMO |
$85.70
|
| Rate for Payer: Cigna of CA PPO |
$99.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.56
|
| Rate for Payer: EPIC Health Plan Senior |
$53.56
|
| Rate for Payer: Galaxy Health WC |
$113.82
|
| Rate for Payer: Global Benefits Group Commercial |
$80.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.52
|
| Rate for Payer: InnovAge PACE Commercial |
$66.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.74
|
| Rate for Payer: Multiplan Commercial |
$100.43
|
| Rate for Payer: Networks By Design Commercial |
$87.04
|
| Rate for Payer: Prime Health Services Commercial |
$113.82
|
| Rate for Payer: Riverside University Health System MISP |
$53.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.95
|
| Rate for Payer: United Healthcare All Other HMO |
$66.95
|
| Rate for Payer: United Healthcare HMO Rider |
$66.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.82
|
| Rate for Payer: Vantage Medical Group Senior |
$113.82
|
|
|
HC DRSNG ACTICOAT 4X4 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$133.91
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Adventist Health Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Central Health Plan Commercial |
$107.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.56
|
| Rate for Payer: EPIC Health Plan Senior |
$53.56
|
| Rate for Payer: Galaxy Health WC |
$113.82
|
| Rate for Payer: Global Benefits Group Commercial |
$80.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.78
|
| Rate for Payer: Multiplan Commercial |
$100.43
|
| Rate for Payer: Networks By Design Commercial |
$87.04
|
| Rate for Payer: Prime Health Services Commercial |
$113.82
|
|
|
HC DRSNG ACTICOAT 4X8 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$194.95
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.99 |
| Max. Negotiated Rate |
$175.46 |
| Rate for Payer: Adventist Health Commercial |
$38.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.49
|
| Rate for Payer: Blue Shield of California Commercial |
$119.11
|
| Rate for Payer: Blue Shield of California EPN |
$77.79
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Central Health Plan Commercial |
$155.96
|
| Rate for Payer: Cigna of CA HMO |
$124.77
|
| Rate for Payer: Cigna of CA PPO |
$144.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.98
|
| Rate for Payer: EPIC Health Plan Senior |
$77.98
|
| Rate for Payer: Galaxy Health WC |
$165.71
|
| Rate for Payer: Global Benefits Group Commercial |
$116.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.46
|
| Rate for Payer: InnovAge PACE Commercial |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$136.47
|
| Rate for Payer: Multiplan Commercial |
$146.21
|
| Rate for Payer: Networks By Design Commercial |
$126.72
|
| Rate for Payer: Prime Health Services Commercial |
$165.71
|
| Rate for Payer: Riverside University Health System MISP |
$77.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.47
|
| Rate for Payer: United Healthcare All Other HMO |
$97.47
|
| Rate for Payer: United Healthcare HMO Rider |
$97.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.71
|
| Rate for Payer: Vantage Medical Group Senior |
$165.71
|
|
