|
HC DRSNG WOUND MEPORE 3.5"X6"
|
Facility
|
OP
|
$3.12
|
|
| Hospital Charge Code |
901604798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1.91
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Central Health Plan Commercial |
$2.50
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.81
|
| Rate for Payer: InnovAge PACE Commercial |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$2.34
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
| Rate for Payer: Riverside University Health System MISP |
$1.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2.65
|
|
|
HC DRSNG WOUND NON-ADHSV 6.125X8"
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901607859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRSNG WOUND NON-ADHSV 6.125X8"
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901607859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC DRSNG WOUND VAC ATS SMALL
|
Facility
|
IP
|
$225.96
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.19 |
| Max. Negotiated Rate |
$203.36 |
| Rate for Payer: Adventist Health Commercial |
$45.19
|
| Rate for Payer: Cash Price |
$101.68
|
| Rate for Payer: Central Health Plan Commercial |
$180.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.38
|
| Rate for Payer: EPIC Health Plan Senior |
$90.38
|
| Rate for Payer: Galaxy Health WC |
$192.07
|
| Rate for Payer: Global Benefits Group Commercial |
$135.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.19
|
| Rate for Payer: Multiplan Commercial |
$169.47
|
| Rate for Payer: Networks By Design Commercial |
$146.87
|
| Rate for Payer: Prime Health Services Commercial |
$192.07
|
|
|
HC DRSNG WOUND VAC ATS SMALL
|
Facility
|
OP
|
$225.96
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$203.36 |
| Rate for Payer: Adventist Health Commercial |
$45.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.71
|
| Rate for Payer: Blue Shield of California Commercial |
$138.06
|
| Rate for Payer: Blue Shield of California EPN |
$90.16
|
| Rate for Payer: Cash Price |
$101.68
|
| Rate for Payer: Cash Price |
$101.68
|
| Rate for Payer: Central Health Plan Commercial |
$180.77
|
| Rate for Payer: Cigna of CA HMO |
$144.61
|
| Rate for Payer: Cigna of CA PPO |
$167.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.38
|
| Rate for Payer: EPIC Health Plan Senior |
$90.38
|
| Rate for Payer: Galaxy Health WC |
$192.07
|
| Rate for Payer: Global Benefits Group Commercial |
$135.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$112.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.17
|
| Rate for Payer: Multiplan Commercial |
$169.47
|
| Rate for Payer: Networks By Design Commercial |
$146.87
|
| Rate for Payer: Prime Health Services Commercial |
$192.07
|
| Rate for Payer: Riverside University Health System MISP |
$90.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.98
|
| Rate for Payer: United Healthcare All Other HMO |
$112.98
|
| Rate for Payer: United Healthcare HMO Rider |
$112.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.07
|
| Rate for Payer: Vantage Medical Group Senior |
$192.07
|
|
|
HC DRSNG WOUND VAC LG
|
Facility
|
OP
|
$343.77
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$309.39 |
| Rate for Payer: Adventist Health Commercial |
$68.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$189.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$257.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$166.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.90
|
| Rate for Payer: Blue Shield of California Commercial |
$210.04
|
| Rate for Payer: Blue Shield of California EPN |
$137.16
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Central Health Plan Commercial |
$275.02
|
| Rate for Payer: Cigna of CA HMO |
$220.01
|
| Rate for Payer: Cigna of CA PPO |
$254.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$292.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$292.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.51
|
| Rate for Payer: EPIC Health Plan Senior |
$137.51
|
| Rate for Payer: Galaxy Health WC |
$292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$206.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$309.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$171.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$212.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$240.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$240.64
|
| Rate for Payer: Multiplan Commercial |
$257.83
|
| Rate for Payer: Networks By Design Commercial |
$223.45
|
| Rate for Payer: Prime Health Services Commercial |
$292.20
|
| Rate for Payer: Riverside University Health System MISP |
$137.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$206.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$206.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.88
|
| Rate for Payer: United Healthcare All Other HMO |
$171.88
|
| Rate for Payer: United Healthcare HMO Rider |
$171.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$292.20
|
| Rate for Payer: Vantage Medical Group Senior |
$292.20
|
|
|
HC DRSNG WOUND VAC LG
|
Facility
|
IP
|
$343.77
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$309.39 |
| Rate for Payer: Adventist Health Commercial |
$68.75
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Central Health Plan Commercial |
$275.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.51
|
| Rate for Payer: EPIC Health Plan Senior |
$137.51
|
| Rate for Payer: Galaxy Health WC |
$292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$206.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$309.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$212.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.75
|
| Rate for Payer: Multiplan Commercial |
$257.83
|
| Rate for Payer: Networks By Design Commercial |
$223.45
|
| Rate for Payer: Prime Health Services Commercial |
$292.20
|
|
|
HC DRSNG WOUND VAC MED BLACK
|
Facility
|
OP
|
$279.16
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$251.24 |
| Rate for Payer: Adventist Health Commercial |
$55.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$237.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.95
|
| Rate for Payer: Blue Shield of California Commercial |
$170.57
|
| Rate for Payer: Blue Shield of California EPN |
$111.38
|
| Rate for Payer: Cash Price |
$125.62
|
| Rate for Payer: Cash Price |
$125.62
|
| Rate for Payer: Central Health Plan Commercial |
$223.33
|
| Rate for Payer: Cigna of CA HMO |
$178.66
|
| Rate for Payer: Cigna of CA PPO |
$206.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$237.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$237.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$237.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.66
|
| Rate for Payer: EPIC Health Plan Senior |
$111.66
|
| Rate for Payer: Galaxy Health WC |
$237.29
|
| Rate for Payer: Global Benefits Group Commercial |
$167.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$251.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$139.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$195.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$195.41
|
| Rate for Payer: Multiplan Commercial |
$209.37
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$237.29
|
| Rate for Payer: Riverside University Health System MISP |
$111.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$167.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$167.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.58
|
| Rate for Payer: United Healthcare All Other HMO |
$139.58
|
| Rate for Payer: United Healthcare HMO Rider |
$139.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$237.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$237.29
|
| Rate for Payer: Vantage Medical Group Senior |
$237.29
|
|
|
HC DRSNG WOUND VAC MED BLACK
|
Facility
|
IP
|
$279.16
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$251.24 |
| Rate for Payer: Adventist Health Commercial |
$55.83
|
| Rate for Payer: Cash Price |
$125.62
|
| Rate for Payer: Central Health Plan Commercial |
$223.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.66
|
| Rate for Payer: EPIC Health Plan Senior |
$111.66
|
| Rate for Payer: Galaxy Health WC |
$237.29
|
| Rate for Payer: Global Benefits Group Commercial |
$167.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$251.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.83
|
| Rate for Payer: Multiplan Commercial |
$209.37
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$237.29
|
|
|
HC DRSNG WOUND VAC MED SLVR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901609001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: 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 WOUND VAC MED SLVR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901609001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$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 |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: 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 WOUND VAC THIN
|
Facility
|
OP
|
$364.82
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$328.34 |
| Rate for Payer: Adventist Health Commercial |
$72.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$176.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.26
|
| Rate for Payer: Blue Shield of California Commercial |
$222.91
|
| Rate for Payer: Blue Shield of California EPN |
$145.56
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Central Health Plan Commercial |
$291.86
|
| Rate for Payer: Cigna of CA HMO |
$233.48
|
| Rate for Payer: Cigna of CA PPO |
$269.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$310.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.93
|
| Rate for Payer: EPIC Health Plan Senior |
$145.93
|
| Rate for Payer: Galaxy Health WC |
$310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$218.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$182.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$255.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$255.37
|
| Rate for Payer: Multiplan Commercial |
$273.62
|
| Rate for Payer: Networks By Design Commercial |
$237.13
|
| Rate for Payer: Prime Health Services Commercial |
$310.10
|
| Rate for Payer: Riverside University Health System MISP |
$145.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.41
|
| Rate for Payer: United Healthcare All Other HMO |
$182.41
|
| Rate for Payer: United Healthcare HMO Rider |
$182.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$182.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.10
|
| Rate for Payer: Vantage Medical Group Senior |
$310.10
|
|
|
HC DRSNG WOUND VAC THIN
|
Facility
|
IP
|
$364.82
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$328.34 |
| Rate for Payer: Adventist Health Commercial |
$72.96
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Central Health Plan Commercial |
$291.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.93
|
| Rate for Payer: EPIC Health Plan Senior |
$145.93
|
| Rate for Payer: Galaxy Health WC |
$310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$218.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.96
|
| Rate for Payer: Multiplan Commercial |
$273.62
|
| Rate for Payer: Networks By Design Commercial |
$237.13
|
| Rate for Payer: Prime Health Services Commercial |
$310.10
|
|
|
HC DRSNG WOUND VAC VERAFLO LRG
|
Facility
|
OP
|
$983.85
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$885.47 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$597.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$476.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$577.82
|
| Rate for Payer: Blue Shield of California Commercial |
$601.13
|
| Rate for Payer: Blue Shield of California EPN |
$392.56
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Central Health Plan Commercial |
$787.08
|
| Rate for Payer: Cigna of CA HMO |
$629.66
|
| Rate for Payer: Cigna of CA PPO |
$728.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$836.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$836.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$836.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$491.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$688.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.70
|
| Rate for Payer: Multiplan Commercial |
$737.89
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
| Rate for Payer: Riverside University Health System MISP |
$393.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.93
|
| Rate for Payer: United Healthcare All Other HMO |
$491.93
|
| Rate for Payer: United Healthcare HMO Rider |
$491.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$836.27
|
| Rate for Payer: Vantage Medical Group Senior |
$836.27
|
|
|
HC DRSNG WOUND VAC VERAFLO LRG
|
Facility
|
IP
|
$983.85
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$885.47 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Central Health Plan Commercial |
$787.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$885.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$656.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$609.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.77
|
| Rate for Payer: Multiplan Commercial |
$737.89
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
|
|
HC DRSNG WOUND VAC VERAFLO MED
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC DRSNG WOUND VAC VERAFLO MED
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC DRSNG WOUND VAC WHITE LG
|
Facility
|
OP
|
$91.28
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$82.15 |
| Rate for Payer: Adventist Health Commercial |
$18.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.61
|
| Rate for Payer: Blue Shield of California Commercial |
$55.77
|
| Rate for Payer: Blue Shield of California EPN |
$36.42
|
| Rate for Payer: Cash Price |
$41.08
|
| Rate for Payer: Cash Price |
$41.08
|
| Rate for Payer: Central Health Plan Commercial |
$73.02
|
| Rate for Payer: Cigna of CA HMO |
$58.42
|
| Rate for Payer: Cigna of CA PPO |
$67.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.51
|
| Rate for Payer: EPIC Health Plan Senior |
$36.51
|
| Rate for Payer: Galaxy Health WC |
$77.59
|
| Rate for Payer: Global Benefits Group Commercial |
$54.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$45.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.90
|
| Rate for Payer: Multiplan Commercial |
$68.46
|
| Rate for Payer: Networks By Design Commercial |
$59.33
|
| Rate for Payer: Prime Health Services Commercial |
$77.59
|
| Rate for Payer: Riverside University Health System MISP |
$36.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.64
|
| Rate for Payer: United Healthcare All Other HMO |
$45.64
|
| Rate for Payer: United Healthcare HMO Rider |
$45.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.59
|
| Rate for Payer: Vantage Medical Group Senior |
$77.59
|
|
|
HC DRSNG WOUND VAC WHITE LG
|
Facility
|
IP
|
$91.28
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$82.15 |
| Rate for Payer: Adventist Health Commercial |
$18.26
|
| Rate for Payer: Cash Price |
$41.08
|
| Rate for Payer: Central Health Plan Commercial |
$73.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.51
|
| Rate for Payer: EPIC Health Plan Senior |
$36.51
|
| Rate for Payer: Galaxy Health WC |
$77.59
|
| Rate for Payer: Global Benefits Group Commercial |
$54.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.26
|
| Rate for Payer: Multiplan Commercial |
$68.46
|
| Rate for Payer: Networks By Design Commercial |
$59.33
|
| Rate for Payer: Prime Health Services Commercial |
$77.59
|
|
|
HC DRSNG WOUND VAC WHITE SM
|
Facility
|
OP
|
$79.29
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$71.36 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.57
|
| Rate for Payer: Blue Shield of California Commercial |
$48.45
|
| Rate for Payer: Blue Shield of California EPN |
$31.64
|
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Central Health Plan Commercial |
$63.43
|
| Rate for Payer: Cigna of CA HMO |
$50.75
|
| Rate for Payer: Cigna of CA PPO |
$58.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.72
|
| Rate for Payer: EPIC Health Plan Senior |
$31.72
|
| Rate for Payer: Galaxy Health WC |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$39.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.50
|
| Rate for Payer: Multiplan Commercial |
$59.47
|
| Rate for Payer: Networks By Design Commercial |
$51.54
|
| Rate for Payer: Prime Health Services Commercial |
$67.40
|
| Rate for Payer: Riverside University Health System MISP |
$31.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.65
|
| Rate for Payer: United Healthcare All Other HMO |
$39.65
|
| Rate for Payer: United Healthcare HMO Rider |
$39.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.40
|
| Rate for Payer: Vantage Medical Group Senior |
$67.40
|
|
|
HC DRSNG WOUND VAC WHITE SM
|
Facility
|
IP
|
$79.29
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$71.36 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Central Health Plan Commercial |
$63.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.72
|
| Rate for Payer: EPIC Health Plan Senior |
$31.72
|
| Rate for Payer: Galaxy Health WC |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.86
|
| Rate for Payer: Multiplan Commercial |
$59.47
|
| Rate for Payer: Networks By Design Commercial |
$51.54
|
| Rate for Payer: Prime Health Services Commercial |
$67.40
|
|
|
HC DRSNG WOUND VAC XLG
|
Facility
|
OP
|
$548.74
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901692012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$493.87 |
| Rate for Payer: Adventist Health Commercial |
$109.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$301.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$411.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$265.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.28
|
| Rate for Payer: Blue Shield of California Commercial |
$335.28
|
| Rate for Payer: Blue Shield of California EPN |
$218.95
|
| Rate for Payer: Cash Price |
$246.93
|
| Rate for Payer: Cash Price |
$246.93
|
| Rate for Payer: Central Health Plan Commercial |
$438.99
|
| Rate for Payer: Cigna of CA HMO |
$351.19
|
| Rate for Payer: Cigna of CA PPO |
$406.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$466.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$466.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.50
|
| Rate for Payer: EPIC Health Plan Senior |
$219.50
|
| Rate for Payer: Galaxy Health WC |
$466.43
|
| Rate for Payer: Global Benefits Group Commercial |
$329.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$493.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$274.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.12
|
| Rate for Payer: Multiplan Commercial |
$411.56
|
| Rate for Payer: Networks By Design Commercial |
$356.68
|
| Rate for Payer: Prime Health Services Commercial |
$466.43
|
| Rate for Payer: Riverside University Health System MISP |
$219.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$329.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$329.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.37
|
| Rate for Payer: United Healthcare All Other HMO |
$274.37
|
| Rate for Payer: United Healthcare HMO Rider |
$274.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$274.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$466.43
|
| Rate for Payer: Vantage Medical Group Senior |
$466.43
|
|
|
HC DRSNG WOUND VAC XLG
|
Facility
|
IP
|
$548.74
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901692012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.75 |
| Max. Negotiated Rate |
$493.87 |
| Rate for Payer: Adventist Health Commercial |
$109.75
|
| Rate for Payer: Cash Price |
$246.93
|
| Rate for Payer: Central Health Plan Commercial |
$438.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.50
|
| Rate for Payer: EPIC Health Plan Senior |
$219.50
|
| Rate for Payer: Galaxy Health WC |
$466.43
|
| Rate for Payer: Global Benefits Group Commercial |
$329.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$493.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.75
|
| Rate for Payer: Multiplan Commercial |
$411.56
|
| Rate for Payer: Networks By Design Commercial |
$356.68
|
| Rate for Payer: Prime Health Services Commercial |
$466.43
|
|
|
HC DRSNG XERFORM ROLL 4"X3YD
|
Facility
|
OP
|
$29.27
|
|
|
Service Code
|
CPT A6224
|
| Hospital Charge Code |
901695706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.19
|
| Rate for Payer: Blue Shield of California Commercial |
$17.88
|
| Rate for Payer: Blue Shield of California EPN |
$11.68
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Central Health Plan Commercial |
$23.42
|
| Rate for Payer: Cigna of CA HMO |
$18.73
|
| Rate for Payer: Cigna of CA PPO |
$21.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.71
|
| Rate for Payer: EPIC Health Plan Senior |
$11.71
|
| Rate for Payer: Galaxy Health WC |
$24.88
|
| Rate for Payer: Global Benefits Group Commercial |
$17.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.34
|
| Rate for Payer: InnovAge PACE Commercial |
$14.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$21.95
|
| Rate for Payer: Networks By Design Commercial |
$19.03
|
| Rate for Payer: Prime Health Services Commercial |
$24.88
|
| Rate for Payer: Riverside University Health System MISP |
$11.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.63
|
| Rate for Payer: United Healthcare All Other HMO |
$14.63
|
| Rate for Payer: United Healthcare HMO Rider |
$14.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.88
|
| Rate for Payer: Vantage Medical Group Senior |
$24.88
|
|
|
HC DRSNG XERFORM ROLL 4"X3YD
|
Facility
|
IP
|
$29.27
|
|
|
Service Code
|
CPT A6224
|
| Hospital Charge Code |
901695706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Central Health Plan Commercial |
$23.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.71
|
| Rate for Payer: EPIC Health Plan Senior |
$11.71
|
| Rate for Payer: Galaxy Health WC |
$24.88
|
| Rate for Payer: Global Benefits Group Commercial |
$17.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.85
|
| Rate for Payer: Multiplan Commercial |
$21.95
|
| Rate for Payer: Networks By Design Commercial |
$19.03
|
| Rate for Payer: Prime Health Services Commercial |
$24.88
|
|
