|
HC DRSNG SHEET 4X5 HD THERAHONEY
|
Facility
|
OP
|
$66.17
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$59.55 |
| Rate for Payer: Adventist Health Commercial |
$13.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.86
|
| Rate for Payer: Blue Shield of California Commercial |
$40.43
|
| Rate for Payer: Blue Shield of California EPN |
$26.40
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Central Health Plan Commercial |
$52.94
|
| Rate for Payer: Cigna of CA HMO |
$42.35
|
| Rate for Payer: Cigna of CA PPO |
$48.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.47
|
| Rate for Payer: EPIC Health Plan Senior |
$26.47
|
| Rate for Payer: Galaxy Health WC |
$56.24
|
| Rate for Payer: Global Benefits Group Commercial |
$39.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.55
|
| Rate for Payer: InnovAge PACE Commercial |
$33.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.32
|
| Rate for Payer: Multiplan Commercial |
$49.63
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$56.24
|
| Rate for Payer: Riverside University Health System MISP |
$26.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.09
|
| Rate for Payer: United Healthcare All Other HMO |
$33.09
|
| Rate for Payer: United Healthcare HMO Rider |
$33.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.24
|
| Rate for Payer: Vantage Medical Group Senior |
$56.24
|
|
|
HC DRSNG SHEET 4X5 HD THERAHONEY
|
Facility
|
IP
|
$66.17
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$59.55 |
| Rate for Payer: Adventist Health Commercial |
$13.23
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Central Health Plan Commercial |
$52.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.47
|
| Rate for Payer: EPIC Health Plan Senior |
$26.47
|
| Rate for Payer: Galaxy Health WC |
$56.24
|
| Rate for Payer: Global Benefits Group Commercial |
$39.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Multiplan Commercial |
$49.63
|
| Rate for Payer: Networks By Design Commercial |
$43.01
|
| Rate for Payer: Prime Health Services Commercial |
$56.24
|
|
|
HC DRSNG SHEET 4X5 THERAHONEY
|
Facility
|
IP
|
$48.79
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$43.91 |
| Rate for Payer: Adventist Health Commercial |
$9.76
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Central Health Plan Commercial |
$39.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.52
|
| Rate for Payer: EPIC Health Plan Senior |
$19.52
|
| Rate for Payer: Galaxy Health WC |
$41.47
|
| Rate for Payer: Global Benefits Group Commercial |
$29.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$36.59
|
| Rate for Payer: Networks By Design Commercial |
$31.71
|
| Rate for Payer: Prime Health Services Commercial |
$41.47
|
|
|
HC DRSNG SHEET 4X5 THERAHONEY
|
Facility
|
OP
|
$48.79
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698901
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$43.91 |
| Rate for Payer: Adventist Health Commercial |
$9.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.65
|
| Rate for Payer: Blue Shield of California Commercial |
$29.81
|
| Rate for Payer: Blue Shield of California EPN |
$19.47
|
| Rate for Payer: Cash Price |
$21.96
|
| Rate for Payer: Central Health Plan Commercial |
$39.03
|
| Rate for Payer: Cigna of CA HMO |
$31.23
|
| Rate for Payer: Cigna of CA PPO |
$36.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.52
|
| Rate for Payer: EPIC Health Plan Senior |
$19.52
|
| Rate for Payer: Galaxy Health WC |
$41.47
|
| Rate for Payer: Global Benefits Group Commercial |
$29.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.91
|
| Rate for Payer: InnovAge PACE Commercial |
$24.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.15
|
| Rate for Payer: Multiplan Commercial |
$36.59
|
| Rate for Payer: Networks By Design Commercial |
$31.71
|
| Rate for Payer: Prime Health Services Commercial |
$41.47
|
| Rate for Payer: Riverside University Health System MISP |
$19.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.39
|
| Rate for Payer: United Healthcare All Other HMO |
$24.39
|
| Rate for Payer: United Healthcare HMO Rider |
$24.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.47
|
| Rate for Payer: Vantage Medical Group Senior |
$41.47
|
|
|
HC DRSNG SILVASORB SITE 1.75 HRTM
|
Facility
|
OP
|
$50.59
|
|
| Hospital Charge Code |
901692017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Adventist Health Commercial |
$10.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.71
|
| Rate for Payer: Blue Shield of California Commercial |
$30.91
|
| Rate for Payer: Blue Shield of California EPN |
$20.19
|
| Rate for Payer: Cash Price |
$22.77
|
| Rate for Payer: Central Health Plan Commercial |
$40.47
|
| Rate for Payer: Cigna of CA HMO |
$32.38
|
| Rate for Payer: Cigna of CA PPO |
$37.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$43.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.53
|
| Rate for Payer: InnovAge PACE Commercial |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.41
|
| Rate for Payer: Multiplan Commercial |
$37.94
|
| Rate for Payer: Networks By Design Commercial |
$32.88
|
| Rate for Payer: Prime Health Services Commercial |
$43.00
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.30
|
| Rate for Payer: United Healthcare All Other HMO |
$25.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.00
|
| Rate for Payer: Vantage Medical Group Senior |
$43.00
|
|
|
HC DRSNG SILVASORB SITE 1.75 HRTM
|
Facility
|
IP
|
$50.59
|
|
| Hospital Charge Code |
901692017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Adventist Health Commercial |
$10.12
|
| Rate for Payer: Cash Price |
$22.77
|
| Rate for Payer: Central Health Plan Commercial |
$40.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$43.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$37.94
|
| Rate for Payer: Networks By Design Commercial |
$32.88
|
| Rate for Payer: Prime Health Services Commercial |
$43.00
|
|
|
HC DRSNG SILVER RESTORE 6X8 IN
|
Facility
|
IP
|
$118.64
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.73 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Adventist Health Commercial |
$23.73
|
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Central Health Plan Commercial |
$94.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.46
|
| Rate for Payer: EPIC Health Plan Senior |
$47.46
|
| Rate for Payer: Galaxy Health WC |
$100.84
|
| Rate for Payer: Global Benefits Group Commercial |
$71.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.73
|
| Rate for Payer: Multiplan Commercial |
$88.98
|
| Rate for Payer: Networks By Design Commercial |
$77.12
|
| Rate for Payer: Prime Health Services Commercial |
$100.84
|
|
|
HC DRSNG SILVER RESTORE 6X8 IN
|
Facility
|
OP
|
$118.64
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.73 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Adventist Health Commercial |
$23.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.68
|
| Rate for Payer: Blue Shield of California Commercial |
$72.49
|
| Rate for Payer: Blue Shield of California EPN |
$47.34
|
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Central Health Plan Commercial |
$94.91
|
| Rate for Payer: Cigna of CA HMO |
$75.93
|
| Rate for Payer: Cigna of CA PPO |
$87.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$100.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.46
|
| Rate for Payer: EPIC Health Plan Senior |
$47.46
|
| Rate for Payer: Galaxy Health WC |
$100.84
|
| Rate for Payer: Global Benefits Group Commercial |
$71.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.78
|
| Rate for Payer: InnovAge PACE Commercial |
$59.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.05
|
| Rate for Payer: Multiplan Commercial |
$88.98
|
| Rate for Payer: Networks By Design Commercial |
$77.12
|
| Rate for Payer: Prime Health Services Commercial |
$100.84
|
| Rate for Payer: Riverside University Health System MISP |
$47.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.32
|
| Rate for Payer: United Healthcare All Other HMO |
$59.32
|
| Rate for Payer: United Healthcare HMO Rider |
$59.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.84
|
| Rate for Payer: Vantage Medical Group Senior |
$100.84
|
|
|
HC DRSNG SILVERSORB 1" ROUND
|
Facility
|
OP
|
$25.58
|
|
| Hospital Charge Code |
901692011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$23.02 |
| Rate for Payer: Adventist Health Commercial |
$5.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.02
|
| Rate for Payer: Blue Shield of California Commercial |
$15.63
|
| Rate for Payer: Blue Shield of California EPN |
$10.21
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Central Health Plan Commercial |
$20.46
|
| Rate for Payer: Cigna of CA HMO |
$16.37
|
| Rate for Payer: Cigna of CA PPO |
$18.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.23
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$21.74
|
| Rate for Payer: Global Benefits Group Commercial |
$15.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.02
|
| Rate for Payer: InnovAge PACE Commercial |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.91
|
| Rate for Payer: Multiplan Commercial |
$19.18
|
| Rate for Payer: Networks By Design Commercial |
$16.63
|
| Rate for Payer: Prime Health Services Commercial |
$21.74
|
| Rate for Payer: Riverside University Health System MISP |
$10.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.79
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Vantage Medical Group Senior |
$21.74
|
|
|
HC DRSNG SILVERSORB 1" ROUND
|
Facility
|
IP
|
$25.58
|
|
| Hospital Charge Code |
901692011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$23.02 |
| Rate for Payer: Adventist Health Commercial |
$5.12
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Central Health Plan Commercial |
$20.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.23
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$21.74
|
| Rate for Payer: Global Benefits Group Commercial |
$15.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.12
|
| Rate for Payer: Multiplan Commercial |
$19.18
|
| Rate for Payer: Networks By Design Commercial |
$16.63
|
| Rate for Payer: Prime Health Services Commercial |
$21.74
|
|
|
HC DRSNG SILVRCEL ALGINATE 1X12"
|
Facility
|
OP
|
$45.10
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Adventist Health Commercial |
$9.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.49
|
| Rate for Payer: Blue Shield of California Commercial |
$27.56
|
| Rate for Payer: Blue Shield of California EPN |
$17.99
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.08
|
| Rate for Payer: Cigna of CA HMO |
$28.86
|
| Rate for Payer: Cigna of CA PPO |
$33.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: EPIC Health Plan Senior |
$18.04
|
| Rate for Payer: Galaxy Health WC |
$38.34
|
| Rate for Payer: Global Benefits Group Commercial |
$27.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.59
|
| Rate for Payer: InnovAge PACE Commercial |
$22.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.57
|
| Rate for Payer: Multiplan Commercial |
$33.83
|
| Rate for Payer: Networks By Design Commercial |
$29.32
|
| Rate for Payer: Prime Health Services Commercial |
$38.34
|
| Rate for Payer: Riverside University Health System MISP |
$18.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.55
|
| Rate for Payer: United Healthcare All Other HMO |
$22.55
|
| Rate for Payer: United Healthcare HMO Rider |
$22.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.34
|
| Rate for Payer: Vantage Medical Group Senior |
$38.34
|
|
|
HC DRSNG SILVRCEL ALGINATE 1X12"
|
Facility
|
IP
|
$45.10
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Adventist Health Commercial |
$9.02
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: EPIC Health Plan Senior |
$18.04
|
| Rate for Payer: Galaxy Health WC |
$38.34
|
| Rate for Payer: Global Benefits Group Commercial |
$27.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$33.83
|
| Rate for Payer: Networks By Design Commercial |
$29.32
|
| Rate for Payer: Prime Health Services Commercial |
$38.34
|
|
|
HC DRSNG SLVR ALGINATE 4"X4.75"
|
Facility
|
IP
|
$44.03
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$35.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$33.02
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
|
|
HC DRSNG SLVR ALGINATE 4"X4.75"
|
Facility
|
OP
|
$44.03
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.86
|
| Rate for Payer: Blue Shield of California Commercial |
$26.90
|
| Rate for Payer: Blue Shield of California EPN |
$17.57
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$35.22
|
| Rate for Payer: Cigna of CA HMO |
$28.18
|
| Rate for Payer: Cigna of CA PPO |
$32.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.63
|
| Rate for Payer: InnovAge PACE Commercial |
$22.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.82
|
| Rate for Payer: Multiplan Commercial |
$33.02
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
| Rate for Payer: Riverside University Health System MISP |
$17.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.02
|
| Rate for Payer: United Healthcare All Other HMO |
$22.02
|
| Rate for Payer: United Healthcare HMO Rider |
$22.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.43
|
| Rate for Payer: Vantage Medical Group Senior |
$37.43
|
|
|
HC DRSNG SLVR AQUACEL AG 3.5X8"
|
Facility
|
OP
|
$251.93
|
|
| Hospital Charge Code |
901698804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$226.74 |
| Rate for Payer: Adventist Health Commercial |
$50.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.96
|
| Rate for Payer: Blue Shield of California Commercial |
$153.93
|
| Rate for Payer: Blue Shield of California EPN |
$100.52
|
| Rate for Payer: Cash Price |
$113.37
|
| Rate for Payer: Central Health Plan Commercial |
$201.54
|
| Rate for Payer: Cigna of CA HMO |
$161.24
|
| Rate for Payer: Cigna of CA PPO |
$186.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.77
|
| Rate for Payer: EPIC Health Plan Senior |
$100.77
|
| Rate for Payer: Galaxy Health WC |
$214.14
|
| Rate for Payer: Global Benefits Group Commercial |
$151.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.74
|
| Rate for Payer: InnovAge PACE Commercial |
$125.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$176.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$176.35
|
| Rate for Payer: Multiplan Commercial |
$188.95
|
| Rate for Payer: Networks By Design Commercial |
$163.75
|
| Rate for Payer: Prime Health Services Commercial |
$214.14
|
| Rate for Payer: Riverside University Health System MISP |
$100.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.97
|
| Rate for Payer: United Healthcare All Other HMO |
$125.97
|
| Rate for Payer: United Healthcare HMO Rider |
$125.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.14
|
| Rate for Payer: Vantage Medical Group Senior |
$214.14
|
|
|
HC DRSNG SLVR AQUACEL AG 3.5X8"
|
Facility
|
IP
|
$251.93
|
|
| Hospital Charge Code |
901698804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$226.74 |
| Rate for Payer: Adventist Health Commercial |
$50.39
|
| Rate for Payer: Cash Price |
$113.37
|
| Rate for Payer: Central Health Plan Commercial |
$201.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.77
|
| Rate for Payer: EPIC Health Plan Senior |
$100.77
|
| Rate for Payer: Galaxy Health WC |
$214.14
|
| Rate for Payer: Global Benefits Group Commercial |
$151.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.39
|
| Rate for Payer: Multiplan Commercial |
$188.95
|
| Rate for Payer: Networks By Design Commercial |
$163.75
|
| Rate for Payer: Prime Health Services Commercial |
$214.14
|
|
|
HC DRSNG SORBAVIEW 3 X 5
|
Facility
|
OP
|
$14.51
|
|
| Hospital Charge Code |
901604069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.52
|
| Rate for Payer: Blue Shield of California Commercial |
$8.87
|
| Rate for Payer: Blue Shield of California EPN |
$5.79
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$11.61
|
| Rate for Payer: Cigna of CA HMO |
$9.29
|
| Rate for Payer: Cigna of CA PPO |
$10.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.80
|
| Rate for Payer: Galaxy Health WC |
$12.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.06
|
| Rate for Payer: InnovAge PACE Commercial |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: Networks By Design Commercial |
$9.43
|
| Rate for Payer: Prime Health Services Commercial |
$12.33
|
| Rate for Payer: Riverside University Health System MISP |
$5.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.25
|
| Rate for Payer: United Healthcare All Other HMO |
$7.25
|
| Rate for Payer: United Healthcare HMO Rider |
$7.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.33
|
|
|
HC DRSNG SORBAVIEW 3 X 5
|
Facility
|
IP
|
$14.51
|
|
| Hospital Charge Code |
901604069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$13.06 |
| Rate for Payer: Adventist Health Commercial |
$2.90
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$11.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5.80
|
| Rate for Payer: Galaxy Health WC |
$12.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: Networks By Design Commercial |
$9.43
|
| Rate for Payer: Prime Health Services Commercial |
$12.33
|
|
|
HC DRSNG SPONGE DRAIN STERILE 2X2"
|
Facility
|
OP
|
$1.07
|
|
| Hospital Charge Code |
901606358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: Blue Shield of California Commercial |
$0.65
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$0.68
|
| Rate for Payer: Cigna of CA PPO |
$0.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.91
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.96
|
| Rate for Payer: InnovAge PACE Commercial |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.91
|
| Rate for Payer: Riverside University Health System MISP |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: Vantage Medical Group Senior |
$0.91
|
|
|
HC DRSNG SPONGE DRAIN STERILE 2X2"
|
Facility
|
IP
|
$1.07
|
|
| Hospital Charge Code |
901606358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.91
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.91
|
|
|
HC DRSNG SQUADERM HYDROGEL 4X4
|
Facility
|
OP
|
$19.19
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901698646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$17.27 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.27
|
| Rate for Payer: Blue Shield of California Commercial |
$11.73
|
| Rate for Payer: Blue Shield of California EPN |
$7.66
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Central Health Plan Commercial |
$15.35
|
| Rate for Payer: Cigna of CA HMO |
$12.28
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$16.31
|
| Rate for Payer: Global Benefits Group Commercial |
$11.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.43
|
| Rate for Payer: Multiplan Commercial |
$14.39
|
| Rate for Payer: Networks By Design Commercial |
$12.47
|
| Rate for Payer: Prime Health Services Commercial |
$16.31
|
| Rate for Payer: Riverside University Health System MISP |
$7.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO |
$9.60
|
| Rate for Payer: United Healthcare HMO Rider |
$9.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.31
|
| Rate for Payer: Vantage Medical Group Senior |
$16.31
|
|
|
HC DRSNG SQUADERM HYDROGEL 4X4
|
Facility
|
IP
|
$19.19
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901698646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$17.27 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Central Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$16.31
|
| Rate for Payer: Global Benefits Group Commercial |
$11.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$14.39
|
| Rate for Payer: Networks By Design Commercial |
$12.47
|
| Rate for Payer: Prime Health Services Commercial |
$16.31
|
|
|
HC DRSNG SURGICAL ABD 8 X 10
|
Facility
|
IP
|
$2.05
|
|
| Hospital Charge Code |
901601557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.74
|
|
|
HC DRSNG SURGICAL ABD 8 X 10
|
Facility
|
OP
|
$2.05
|
|
| Hospital Charge Code |
901601557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.82
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.64
|
| Rate for Payer: Cigna of CA HMO |
$1.31
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.84
|
| Rate for Payer: InnovAge PACE Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.74
|
| Rate for Payer: Riverside University Health System MISP |
$0.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1.02
|
| Rate for Payer: United Healthcare HMO Rider |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
HC DRSNG TEGADERM 1 3/4 X 1 3/4
|
Facility
|
OP
|
$2.13
|
|
| Hospital Charge Code |
901698418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
| Rate for Payer: Riverside University Health System MISP |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1.81
|
|
