|
HC DRSNG QUICKCLOT Z-FOLD
|
Facility
|
OP
|
$304.92
|
|
| Hospital Charge Code |
901608008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$274.43 |
| Rate for Payer: Adventist Health Commercial |
$60.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.08
|
| Rate for Payer: Blue Shield of California Commercial |
$186.31
|
| Rate for Payer: Blue Shield of California EPN |
$121.66
|
| Rate for Payer: Cash Price |
$167.71
|
| Rate for Payer: Central Health Plan Commercial |
$243.94
|
| Rate for Payer: Cigna of CA HMO |
$195.15
|
| Rate for Payer: Cigna of CA PPO |
$225.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.97
|
| Rate for Payer: EPIC Health Plan Senior |
$121.97
|
| Rate for Payer: Galaxy Health WC |
$259.18
|
| Rate for Payer: Global Benefits Group Commercial |
$182.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.43
|
| Rate for Payer: InnovAge PACE Commercial |
$152.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.44
|
| Rate for Payer: Multiplan Commercial |
$228.69
|
| Rate for Payer: Networks By Design Commercial |
$198.20
|
| Rate for Payer: Prime Health Services Commercial |
$259.18
|
| Rate for Payer: Riverside University Health System MISP |
$121.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.46
|
| Rate for Payer: United Healthcare All Other HMO |
$152.46
|
| Rate for Payer: United Healthcare HMO Rider |
$152.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.18
|
| Rate for Payer: Vantage Medical Group Senior |
$259.18
|
|
|
HC DRSNG QUICKCLOT Z-FOLD
|
Facility
|
IP
|
$304.92
|
|
| Hospital Charge Code |
901608008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.98 |
| Max. Negotiated Rate |
$274.43 |
| Rate for Payer: Adventist Health Commercial |
$60.98
|
| Rate for Payer: Cash Price |
$167.71
|
| Rate for Payer: Central Health Plan Commercial |
$243.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.97
|
| Rate for Payer: EPIC Health Plan Senior |
$121.97
|
| Rate for Payer: Galaxy Health WC |
$259.18
|
| Rate for Payer: Global Benefits Group Commercial |
$182.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.98
|
| Rate for Payer: Multiplan Commercial |
$228.69
|
| Rate for Payer: Networks By Design Commercial |
$198.20
|
| Rate for Payer: Prime Health Services Commercial |
$259.18
|
|
|
HC DRSNG RENASYS ABD KIT
|
Facility
|
IP
|
$224.70
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$202.23 |
| Rate for Payer: Adventist Health Commercial |
$44.94
|
| Rate for Payer: Cash Price |
$123.59
|
| Rate for Payer: Central Health Plan Commercial |
$179.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.88
|
| Rate for Payer: EPIC Health Plan Senior |
$89.88
|
| Rate for Payer: Galaxy Health WC |
$191.00
|
| Rate for Payer: Global Benefits Group Commercial |
$134.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.94
|
| Rate for Payer: Multiplan Commercial |
$168.53
|
| Rate for Payer: Networks By Design Commercial |
$146.06
|
| Rate for Payer: Prime Health Services Commercial |
$191.00
|
|
|
HC DRSNG RENASYS ABD KIT
|
Facility
|
OP
|
$224.70
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$202.23 |
| Rate for Payer: Adventist Health Commercial |
$44.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.97
|
| Rate for Payer: Blue Shield of California Commercial |
$137.29
|
| Rate for Payer: Blue Shield of California EPN |
$89.66
|
| Rate for Payer: Cash Price |
$123.59
|
| Rate for Payer: Cash Price |
$123.59
|
| Rate for Payer: Central Health Plan Commercial |
$179.76
|
| Rate for Payer: Cigna of CA HMO |
$143.81
|
| Rate for Payer: Cigna of CA PPO |
$166.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.88
|
| Rate for Payer: EPIC Health Plan Senior |
$89.88
|
| Rate for Payer: Galaxy Health WC |
$191.00
|
| Rate for Payer: Global Benefits Group Commercial |
$134.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$112.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.29
|
| Rate for Payer: Multiplan Commercial |
$168.53
|
| Rate for Payer: Networks By Design Commercial |
$146.06
|
| Rate for Payer: Prime Health Services Commercial |
$191.00
|
| Rate for Payer: Riverside University Health System MISP |
$89.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.35
|
| Rate for Payer: United Healthcare All Other HMO |
$112.35
|
| Rate for Payer: United Healthcare HMO Rider |
$112.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.00
|
| Rate for Payer: Vantage Medical Group Senior |
$191.00
|
|
|
HC DRSNG RENASYS F-FOAM LG KIT
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$213.85
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC DRSNG RENASYS F-FOAM LG KIT
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC DRSNG RENSASYS F-FOAM SM KIT
|
Facility
|
OP
|
$47.48
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$9.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.89
|
| Rate for Payer: Blue Shield of California Commercial |
$29.01
|
| Rate for Payer: Blue Shield of California EPN |
$18.94
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Central Health Plan Commercial |
$37.98
|
| Rate for Payer: Cigna of CA HMO |
$30.39
|
| Rate for Payer: Cigna of CA PPO |
$35.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: EPIC Health Plan Senior |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$23.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.24
|
| Rate for Payer: Multiplan Commercial |
$35.61
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
| Rate for Payer: Riverside University Health System MISP |
$18.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.74
|
| Rate for Payer: United Healthcare All Other HMO |
$23.74
|
| Rate for Payer: United Healthcare HMO Rider |
$23.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.36
|
| Rate for Payer: Vantage Medical Group Senior |
$40.36
|
|
|
HC DRSNG RENSASYS F-FOAM SM KIT
|
Facility
|
IP
|
$47.48
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$9.50
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Central Health Plan Commercial |
$37.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: EPIC Health Plan Senior |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$35.61
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
|
|
HC DRSNG SHEET 2X2 HD THERAHONEY
|
Facility
|
IP
|
$29.19
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901698902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$26.27 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11.68
|
| Rate for Payer: Galaxy Health WC |
$24.81
|
| Rate for Payer: Global Benefits Group Commercial |
$17.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Multiplan Commercial |
$21.89
|
| Rate for Payer: Networks By Design Commercial |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$24.81
|
|
|
HC DRSNG SHEET 2X2 HD THERAHONEY
|
Facility
|
OP
|
$29.19
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901698902
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$26.27 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.14
|
| Rate for Payer: Blue Shield of California Commercial |
$17.84
|
| Rate for Payer: Blue Shield of California EPN |
$11.65
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.35
|
| Rate for Payer: Cigna of CA HMO |
$18.68
|
| Rate for Payer: Cigna of CA PPO |
$21.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11.68
|
| Rate for Payer: Galaxy Health WC |
$24.81
|
| Rate for Payer: Global Benefits Group Commercial |
$17.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.27
|
| Rate for Payer: InnovAge PACE Commercial |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.43
|
| Rate for Payer: Multiplan Commercial |
$21.89
|
| Rate for Payer: Networks By Design Commercial |
$18.97
|
| Rate for Payer: Prime Health Services Commercial |
$24.81
|
| Rate for Payer: Riverside University Health System MISP |
$11.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.60
|
| Rate for Payer: United Healthcare All Other HMO |
$14.60
|
| Rate for Payer: United Healthcare HMO Rider |
$14.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.81
|
|
|
HC DRSNG SHEET 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 |
$36.39
|
| 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 |
$36.39
|
| 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 |
$26.83
|
| 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 |
$26.83
|
| 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 |
$27.82
|
| 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 |
$27.82
|
| 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 |
$65.25
|
| 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 |
$65.25
|
| 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
|
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 |
$14.07
|
| 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 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 |
$14.07
|
| 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 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 |
$24.81
|
| 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 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 |
$24.81
|
| 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 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 |
$24.22
|
| 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 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 |
$24.22
|
| 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 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 |
$138.56
|
| 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
|
|
