|
HC DROP LOCK RETAINER PER BAR
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
905352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Blue Shield of California EPN |
$25.10
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.75
|
| Rate for Payer: United Healthcare All Other HMO |
$17.33
|
| Rate for Payer: United Healthcare HMO Rider |
$16.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.51
|
|
|
HC DRSG AQUACEL HYDROFIBER 23CMX30CM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| 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 |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| 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 Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| 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: 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
|
| 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 Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC DRSG AQUACEL HYDROFIBER 23CMX30CM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| 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: 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: 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 DRSG AQUACEL HYDROFIBR .75X18"
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| 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: 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: 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 DRSG AQUACEL HYDROFIBR .75X18"
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| 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 |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| 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 Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| 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: 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
|
| 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 Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRSG IV ADV CNTL LNE 4X4 3/4IN
|
Facility
|
OP
|
$7.87
|
|
| Hospital Charge Code |
901606218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.65
|
| Rate for Payer: Blue Distinction Transplant |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.95
|
| Rate for Payer: Blue Shield of California EPN |
$3.85
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Central Health Plan Commercial |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.69
|
| Rate for Payer: Dignity Health Media |
$6.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.15
|
| Rate for Payer: Galaxy Health WC |
$6.69
|
| Rate for Payer: Global Benefits Group Commercial |
$4.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$5.12
|
| Rate for Payer: Prime Health Services Commercial |
$6.69
|
| Rate for Payer: Riverside University Health System MISP |
$3.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.94
|
| Rate for Payer: United Healthcare All Other HMO |
$3.94
|
| Rate for Payer: United Healthcare HMO Rider |
$3.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.69
|
| Rate for Payer: Vantage Medical Group Senior |
$6.69
|
|
|
HC DRSG IV ADV CNTL LNE 4X4 3/4IN
|
Facility
|
IP
|
$7.87
|
|
| Hospital Charge Code |
901606218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Central Health Plan Commercial |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.15
|
| Rate for Payer: Galaxy Health WC |
$6.69
|
| Rate for Payer: Global Benefits Group Commercial |
$4.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$5.12
|
| Rate for Payer: Prime Health Services Commercial |
$6.69
|
|
|
HC DRSG POLY 3.5X3.5 NON-ADH FOAM
|
Facility
|
OP
|
$22.80
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.47
|
| Rate for Payer: Blue Distinction Transplant |
$13.68
|
| Rate for Payer: Blue Shield of California Commercial |
$14.34
|
| Rate for Payer: Blue Shield of California EPN |
$11.15
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Central Health Plan Commercial |
$18.24
|
| Rate for Payer: Cigna of CA HMO |
$14.59
|
| Rate for Payer: Cigna of CA PPO |
$16.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.38
|
| Rate for Payer: Dignity Health Media |
$19.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.12
|
| Rate for Payer: Galaxy Health WC |
$19.38
|
| Rate for Payer: Global Benefits Group Commercial |
$13.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$17.10
|
| Rate for Payer: Networks By Design Commercial |
$14.82
|
| Rate for Payer: Prime Health Services Commercial |
$19.38
|
| Rate for Payer: Riverside University Health System MISP |
$9.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.40
|
| Rate for Payer: United Healthcare All Other HMO |
$11.40
|
| Rate for Payer: United Healthcare HMO Rider |
$11.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.38
|
| Rate for Payer: Vantage Medical Group Senior |
$19.38
|
|
|
HC DRSG POLY 3.5X3.5 NON-ADH FOAM
|
Facility
|
IP
|
$22.80
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$20.52 |
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Central Health Plan Commercial |
$18.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.12
|
| Rate for Payer: Galaxy Health WC |
$19.38
|
| Rate for Payer: Global Benefits Group Commercial |
$13.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$17.10
|
| Rate for Payer: Networks By Design Commercial |
$14.82
|
| Rate for Payer: Prime Health Services Commercial |
$19.38
|
|
|
HC DRSNG ABD ABTHERA SENSATR
|
Facility
|
IP
|
$2,200.64
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.13 |
| Max. Negotiated Rate |
$1,980.58 |
| Rate for Payer: Cash Price |
$990.29
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.26
|
| Rate for Payer: Galaxy Health WC |
$1,870.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.13
|
| Rate for Payer: Multiplan Commercial |
$1,650.48
|
| Rate for Payer: Networks By Design Commercial |
$1,430.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.54
|
|
|
HC DRSNG ABD ABTHERA SENSATR
|
Facility
|
OP
|
$2,200.64
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$1,980.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,210.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,065.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,300.14
|
| Rate for Payer: Blue Distinction Transplant |
$1,320.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,384.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,076.11
|
| Rate for Payer: Cash Price |
$990.29
|
| Rate for Payer: Cash Price |
$990.29
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.51
|
| Rate for Payer: Cigna of CA HMO |
$1,408.41
|
| Rate for Payer: Cigna of CA PPO |
$1,628.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Dignity Health Media |
$1,870.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$880.26
|
| Rate for Payer: Galaxy Health WC |
$1,870.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,650.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$770.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.13
|
| Rate for Payer: Multiplan Commercial |
$1,650.48
|
| Rate for Payer: Networks By Design Commercial |
$1,430.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.54
|
| Rate for Payer: Riverside University Health System MISP |
$880.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,100.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,100.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,100.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,100.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.54
|
|
|
HC DRSNG ABSORBENT FOAM 4X4 MIPILEX
|
Facility
|
OP
|
$57.15
|
|
| Hospital Charge Code |
901696386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$51.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.76
|
| Rate for Payer: Blue Distinction Transplant |
$34.29
|
| Rate for Payer: Blue Shield of California Commercial |
$35.95
|
| Rate for Payer: Blue Shield of California EPN |
$27.95
|
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Central Health Plan Commercial |
$45.72
|
| Rate for Payer: Cigna of CA HMO |
$36.58
|
| Rate for Payer: Cigna of CA PPO |
$42.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.58
|
| Rate for Payer: Dignity Health Media |
$48.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.86
|
| Rate for Payer: Galaxy Health WC |
$48.58
|
| Rate for Payer: Global Benefits Group Commercial |
$34.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.43
|
| Rate for Payer: Multiplan Commercial |
$42.86
|
| Rate for Payer: Networks By Design Commercial |
$37.15
|
| Rate for Payer: Prime Health Services Commercial |
$48.58
|
| Rate for Payer: Riverside University Health System MISP |
$22.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.58
|
| Rate for Payer: United Healthcare All Other HMO |
$28.58
|
| Rate for Payer: United Healthcare HMO Rider |
$28.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.58
|
| Rate for Payer: Vantage Medical Group Senior |
$48.58
|
|
|
HC DRSNG ABSORBENT FOAM 4X4 MIPILEX
|
Facility
|
IP
|
$57.15
|
|
| Hospital Charge Code |
901696386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$51.44 |
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Central Health Plan Commercial |
$45.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.86
|
| Rate for Payer: Galaxy Health WC |
$48.58
|
| Rate for Payer: Global Benefits Group Commercial |
$34.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.43
|
| Rate for Payer: Multiplan Commercial |
$42.86
|
| Rate for Payer: Networks By Design Commercial |
$37.15
|
| Rate for Payer: Prime Health Services Commercial |
$48.58
|
|
|
HC DRSNG ACTICOAT 4X10 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$210.77
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$189.69 |
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Central Health Plan Commercial |
$168.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.31
|
| Rate for Payer: Galaxy Health WC |
$179.15
|
| Rate for Payer: Global Benefits Group Commercial |
$126.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.15
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Networks By Design Commercial |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$179.15
|
|
|
HC DRSNG ACTICOAT 4X10 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$210.77
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$189.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.52
|
| Rate for Payer: Blue Distinction Transplant |
$126.46
|
| Rate for Payer: Blue Shield of California Commercial |
$132.57
|
| Rate for Payer: Blue Shield of California EPN |
$103.07
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Central Health Plan Commercial |
$168.62
|
| Rate for Payer: Cigna of CA HMO |
$134.89
|
| Rate for Payer: Cigna of CA PPO |
$155.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.15
|
| Rate for Payer: Dignity Health Media |
$179.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$179.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.31
|
| Rate for Payer: Galaxy Health WC |
$179.15
|
| Rate for Payer: Global Benefits Group Commercial |
$126.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$158.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.15
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Networks By Design Commercial |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$179.15
|
| Rate for Payer: Riverside University Health System MISP |
$84.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.38
|
| Rate for Payer: United Healthcare All Other HMO |
$105.38
|
| Rate for Payer: United Healthcare HMO Rider |
$105.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$179.15
|
| Rate for Payer: Vantage Medical Group Senior |
$179.15
|
|
|
HC DRSNG ACTICOAT 4X13 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$803.53
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901606857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$723.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$683.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$441.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$441.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$389.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$474.73
|
| Rate for Payer: Blue Distinction Transplant |
$482.12
|
| Rate for Payer: Blue Shield of California Commercial |
$505.42
|
| Rate for Payer: Blue Shield of California EPN |
$392.93
|
| Rate for Payer: Cash Price |
$361.59
|
| Rate for Payer: Cash Price |
$361.59
|
| Rate for Payer: Central Health Plan Commercial |
$642.82
|
| Rate for Payer: Cigna of CA HMO |
$514.26
|
| Rate for Payer: Cigna of CA PPO |
$594.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$683.00
|
| Rate for Payer: Dignity Health Media |
$683.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$683.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$321.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$321.41
|
| Rate for Payer: Galaxy Health WC |
$683.00
|
| Rate for Payer: Global Benefits Group Commercial |
$482.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$723.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$602.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$281.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$535.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.71
|
| Rate for Payer: Multiplan Commercial |
$602.65
|
| Rate for Payer: Networks By Design Commercial |
$522.29
|
| Rate for Payer: Prime Health Services Commercial |
$683.00
|
| Rate for Payer: Riverside University Health System MISP |
$321.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$482.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$482.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$401.76
|
| Rate for Payer: United Healthcare All Other HMO |
$401.76
|
| Rate for Payer: United Healthcare HMO Rider |
$401.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$401.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$683.00
|
| Rate for Payer: Vantage Medical Group Senior |
$683.00
|
|
|
HC DRSNG ACTICOAT 4X13 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$803.53
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901606857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.71 |
| Max. Negotiated Rate |
$723.18 |
| Rate for Payer: Cash Price |
$361.59
|
| Rate for Payer: Central Health Plan Commercial |
$642.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$321.41
|
| Rate for Payer: Galaxy Health WC |
$683.00
|
| Rate for Payer: Global Benefits Group Commercial |
$482.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$723.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$535.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.71
|
| Rate for Payer: Multiplan Commercial |
$602.65
|
| Rate for Payer: Networks By Design Commercial |
$522.29
|
| Rate for Payer: Prime Health Services Commercial |
$683.00
|
|
|
HC DRSNG ACTICOAT 4X4 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$41.49
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$37.34 |
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Central Health Plan Commercial |
$33.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.60
|
| Rate for Payer: Galaxy Health WC |
$35.27
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| Rate for Payer: Multiplan Commercial |
$31.12
|
| Rate for Payer: Networks By Design Commercial |
$26.97
|
| Rate for Payer: Prime Health Services Commercial |
$35.27
|
|
|
HC DRSNG ACTICOAT 4X4 3/4 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$41.49
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$37.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.51
|
| Rate for Payer: Blue Distinction Transplant |
$24.89
|
| Rate for Payer: Blue Shield of California Commercial |
$26.10
|
| Rate for Payer: Blue Shield of California EPN |
$20.29
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Central Health Plan Commercial |
$33.19
|
| Rate for Payer: Cigna of CA HMO |
$26.55
|
| Rate for Payer: Cigna of CA PPO |
$30.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.27
|
| Rate for Payer: Dignity Health Media |
$35.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.60
|
| Rate for Payer: Galaxy Health WC |
$35.27
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$31.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| Rate for Payer: Multiplan Commercial |
$31.12
|
| Rate for Payer: Networks By Design Commercial |
$26.97
|
| Rate for Payer: Prime Health Services Commercial |
$35.27
|
| Rate for Payer: Riverside University Health System MISP |
$16.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.74
|
| Rate for Payer: United Healthcare All Other HMO |
$20.74
|
| Rate for Payer: United Healthcare HMO Rider |
$20.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.27
|
| Rate for Payer: Vantage Medical Group Senior |
$35.27
|
|
|
HC DRSNG ACTICOAT 4X8 ANTIMICROBIAL SURGICAL
|
Facility
|
OP
|
$164.50
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.19
|
| Rate for Payer: Blue Distinction Transplant |
$98.70
|
| Rate for Payer: Blue Shield of California Commercial |
$103.47
|
| Rate for Payer: Blue Shield of California EPN |
$80.44
|
| Rate for Payer: Cash Price |
$74.03
|
| Rate for Payer: Cash Price |
$74.03
|
| Rate for Payer: Central Health Plan Commercial |
$131.60
|
| Rate for Payer: Cigna of CA HMO |
$105.28
|
| Rate for Payer: Cigna of CA PPO |
$121.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.82
|
| Rate for Payer: Dignity Health Media |
$139.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.80
|
| Rate for Payer: Galaxy Health WC |
$139.82
|
| Rate for Payer: Global Benefits Group Commercial |
$98.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$123.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$123.38
|
| Rate for Payer: Networks By Design Commercial |
$106.92
|
| Rate for Payer: Prime Health Services Commercial |
$139.82
|
| Rate for Payer: Riverside University Health System MISP |
$65.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.25
|
| Rate for Payer: United Healthcare All Other HMO |
$82.25
|
| Rate for Payer: United Healthcare HMO Rider |
$82.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.82
|
| Rate for Payer: Vantage Medical Group Senior |
$139.82
|
|
|
HC DRSNG ACTICOAT 4X8 ANTIMICROBIAL SURGICAL
|
Facility
|
IP
|
$164.50
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901606871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Cash Price |
$74.03
|
| Rate for Payer: Central Health Plan Commercial |
$131.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.80
|
| Rate for Payer: Galaxy Health WC |
$139.82
|
| Rate for Payer: Global Benefits Group Commercial |
$98.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$123.38
|
| Rate for Payer: Networks By Design Commercial |
$106.92
|
| Rate for Payer: Prime Health Services Commercial |
$139.82
|
|
|
HC DRSNG ACTICOAT 4X8" FLX 3
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.27 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.80
|
| Rate for Payer: Blue Distinction Transplant |
$91.20
|
| Rate for Payer: Blue Shield of California Commercial |
$95.61
|
| Rate for Payer: Blue Shield of California EPN |
$74.33
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Media |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$114.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC DRSNG ACTICOAT 4X8" FLX 3
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698299
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC DRSNG ACTICOAT 8"X16" 231304
|
Facility
|
IP
|
$304.22
|
|
|
Service Code
|
CPT A6253
|
| Hospital Charge Code |
901698100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$273.80 |
| Rate for Payer: Cash Price |
$136.90
|
| Rate for Payer: Central Health Plan Commercial |
$243.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.69
|
| Rate for Payer: Galaxy Health WC |
$258.59
|
| Rate for Payer: Global Benefits Group Commercial |
$182.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.84
|
| Rate for Payer: Multiplan Commercial |
$228.16
|
| Rate for Payer: Networks By Design Commercial |
$197.74
|
| Rate for Payer: Prime Health Services Commercial |
$258.59
|
|
|
HC DRSNG ACTICOAT 8"X16" 231304
|
Facility
|
OP
|
$304.22
|
|
|
Service Code
|
CPT A6253
|
| Hospital Charge Code |
901698100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.63 |
| Max. Negotiated Rate |
$273.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.73
|
| Rate for Payer: Blue Distinction Transplant |
$182.53
|
| Rate for Payer: Blue Shield of California Commercial |
$191.35
|
| Rate for Payer: Blue Shield of California EPN |
$148.76
|
| Rate for Payer: Cash Price |
$136.90
|
| Rate for Payer: Cash Price |
$136.90
|
| Rate for Payer: Central Health Plan Commercial |
$243.38
|
| Rate for Payer: Cigna of CA HMO |
$194.70
|
| Rate for Payer: Cigna of CA PPO |
$225.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.59
|
| Rate for Payer: Dignity Health Media |
$258.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$258.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$121.69
|
| Rate for Payer: Galaxy Health WC |
$258.59
|
| Rate for Payer: Global Benefits Group Commercial |
$182.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.84
|
| Rate for Payer: Multiplan Commercial |
$228.16
|
| Rate for Payer: Networks By Design Commercial |
$197.74
|
| Rate for Payer: Prime Health Services Commercial |
$258.59
|
| Rate for Payer: Riverside University Health System MISP |
$121.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.11
|
| Rate for Payer: United Healthcare All Other HMO |
$152.11
|
| Rate for Payer: United Healthcare HMO Rider |
$152.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$258.59
|
| Rate for Payer: Vantage Medical Group Senior |
$258.59
|
|
