|
HC DRSNG GAUZE XEROFRM 1X8"
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
|
HC DRSNG GAUZE XEROFRM 5X9"
|
Facility
|
OP
|
$5.41
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.20
|
| Rate for Payer: Blue Distinction Transplant |
$3.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$4.33
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$4.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.60
|
| Rate for Payer: Dignity Health Media |
$4.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.60
|
| Rate for Payer: Riverside University Health System MISP |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4.60
|
|
|
HC DRSNG GAUZE XEROFRM 5X9"
|
Facility
|
IP
|
$5.41
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.60
|
|
|
HC DRSNG HEMOSTAT SURGICEL 1X2
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901603833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.22
|
| 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: 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 DRSNG HEMOSTAT SURGICEL 1X2
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901603833
|
|
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 DRSNG HEMOSTAT SURGICEL 2X14
|
Facility
|
IP
|
$313.08
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901604356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.62 |
| Max. Negotiated Rate |
$281.77 |
| Rate for Payer: Cash Price |
$140.89
|
| Rate for Payer: Central Health Plan Commercial |
$250.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.23
|
| Rate for Payer: Galaxy Health WC |
$266.12
|
| Rate for Payer: Global Benefits Group Commercial |
$187.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.62
|
| Rate for Payer: Multiplan Commercial |
$234.81
|
| Rate for Payer: Networks By Design Commercial |
$203.50
|
| Rate for Payer: Prime Health Services Commercial |
$266.12
|
|
|
HC DRSNG HEMOSTAT SURGICEL 2X14
|
Facility
|
OP
|
$313.08
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901604356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$281.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$266.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$172.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.97
|
| Rate for Payer: Blue Distinction Transplant |
$187.85
|
| Rate for Payer: Blue Shield of California Commercial |
$196.93
|
| Rate for Payer: Blue Shield of California EPN |
$153.10
|
| Rate for Payer: Cash Price |
$140.89
|
| Rate for Payer: Cash Price |
$140.89
|
| Rate for Payer: Central Health Plan Commercial |
$250.46
|
| Rate for Payer: Cigna of CA HMO |
$200.37
|
| Rate for Payer: Cigna of CA PPO |
$231.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$266.12
|
| Rate for Payer: Dignity Health Media |
$266.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$266.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$125.23
|
| Rate for Payer: Galaxy Health WC |
$266.12
|
| Rate for Payer: Global Benefits Group Commercial |
$187.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.77
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$234.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.62
|
| Rate for Payer: Multiplan Commercial |
$234.81
|
| Rate for Payer: Networks By Design Commercial |
$203.50
|
| Rate for Payer: Prime Health Services Commercial |
$266.12
|
| Rate for Payer: Riverside University Health System MISP |
$125.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.54
|
| Rate for Payer: United Healthcare All Other HMO |
$156.54
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$266.12
|
| Rate for Payer: Vantage Medical Group Senior |
$266.12
|
|
|
HC DRSNG HEMOSTAT SURGICEL 2X3
|
Facility
|
OP
|
$224.91
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901603931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$202.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.88
|
| Rate for Payer: Blue Distinction Transplant |
$134.95
|
| Rate for Payer: Blue Shield of California Commercial |
$141.47
|
| Rate for Payer: Blue Shield of California EPN |
$109.98
|
| Rate for Payer: Cash Price |
$101.21
|
| Rate for Payer: Cash Price |
$101.21
|
| Rate for Payer: Central Health Plan Commercial |
$179.93
|
| Rate for Payer: Cigna of CA HMO |
$143.94
|
| Rate for Payer: Cigna of CA PPO |
$166.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.17
|
| Rate for Payer: Dignity Health Media |
$191.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$89.96
|
| Rate for Payer: Galaxy Health WC |
$191.17
|
| Rate for Payer: Global Benefits Group Commercial |
$134.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.98
|
| Rate for Payer: Multiplan Commercial |
$168.68
|
| Rate for Payer: Networks By Design Commercial |
$146.19
|
| Rate for Payer: Prime Health Services Commercial |
$191.17
|
| Rate for Payer: Riverside University Health System MISP |
$89.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.46
|
| Rate for Payer: United Healthcare All Other HMO |
$112.46
|
| Rate for Payer: United Healthcare HMO Rider |
$112.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.17
|
| Rate for Payer: Vantage Medical Group Senior |
$191.17
|
|
|
HC DRSNG HEMOSTAT SURGICEL 2X3
|
Facility
|
IP
|
$224.91
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901603931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$202.42 |
| Rate for Payer: Cash Price |
$101.21
|
| Rate for Payer: Central Health Plan Commercial |
$179.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.96
|
| Rate for Payer: Galaxy Health WC |
$191.17
|
| Rate for Payer: Global Benefits Group Commercial |
$134.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.98
|
| Rate for Payer: Multiplan Commercial |
$168.68
|
| Rate for Payer: Networks By Design Commercial |
$146.19
|
| Rate for Payer: Prime Health Services Commercial |
$191.17
|
|
|
HC DRSNG HYDROFERA FOAM BLUE 4X5"
|
Facility
|
OP
|
$56.17
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$52.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.19
|
| Rate for Payer: Blue Distinction Transplant |
$33.70
|
| Rate for Payer: Blue Shield of California Commercial |
$35.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.47
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Central Health Plan Commercial |
$44.94
|
| Rate for Payer: Cigna of CA HMO |
$35.95
|
| Rate for Payer: Cigna of CA PPO |
$41.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.74
|
| Rate for Payer: Dignity Health Media |
$47.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.47
|
| Rate for Payer: Galaxy Health WC |
$47.74
|
| Rate for Payer: Global Benefits Group Commercial |
$33.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.55
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$42.13
|
| Rate for Payer: Networks By Design Commercial |
$36.51
|
| Rate for Payer: Prime Health Services Commercial |
$47.74
|
| Rate for Payer: Riverside University Health System MISP |
$22.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.08
|
| Rate for Payer: United Healthcare All Other HMO |
$28.08
|
| Rate for Payer: United Healthcare HMO Rider |
$28.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.74
|
| Rate for Payer: Vantage Medical Group Senior |
$47.74
|
|
|
HC DRSNG HYDROFERA FOAM BLUE 4X5"
|
Facility
|
IP
|
$56.17
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$50.55 |
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Central Health Plan Commercial |
$44.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.47
|
| Rate for Payer: Galaxy Health WC |
$47.74
|
| Rate for Payer: Global Benefits Group Commercial |
$33.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.23
|
| Rate for Payer: Multiplan Commercial |
$42.13
|
| Rate for Payer: Networks By Design Commercial |
$36.51
|
| Rate for Payer: Prime Health Services Commercial |
$47.74
|
|
|
HC DRSNG HYDROGEL 2.4X2.4"
|
Facility
|
IP
|
$35.26
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901698329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Central Health Plan Commercial |
$28.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.10
|
| Rate for Payer: Galaxy Health WC |
$29.97
|
| Rate for Payer: Global Benefits Group Commercial |
$21.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$26.44
|
| Rate for Payer: Networks By Design Commercial |
$22.92
|
| Rate for Payer: Prime Health Services Commercial |
$29.97
|
|
|
HC DRSNG HYDROGEL 2.4X2.4"
|
Facility
|
OP
|
$35.26
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901698329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.83
|
| Rate for Payer: Blue Distinction Transplant |
$21.16
|
| Rate for Payer: Blue Shield of California Commercial |
$22.18
|
| Rate for Payer: Blue Shield of California EPN |
$17.24
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Central Health Plan Commercial |
$28.21
|
| Rate for Payer: Cigna of CA HMO |
$22.57
|
| Rate for Payer: Cigna of CA PPO |
$26.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.97
|
| Rate for Payer: Dignity Health Media |
$29.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.10
|
| Rate for Payer: Galaxy Health WC |
$29.97
|
| Rate for Payer: Global Benefits Group Commercial |
$21.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$26.44
|
| Rate for Payer: Networks By Design Commercial |
$22.92
|
| Rate for Payer: Prime Health Services Commercial |
$29.97
|
| Rate for Payer: Riverside University Health System MISP |
$14.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.63
|
| Rate for Payer: United Healthcare All Other HMO |
$17.63
|
| Rate for Payer: United Healthcare HMO Rider |
$17.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.97
|
| Rate for Payer: Vantage Medical Group Senior |
$29.97
|
|
|
HC DRSNG HYDROGEL MCKESSN 4X4" SQ
|
Facility
|
IP
|
$38.54
|
|
| Hospital Charge Code |
901698647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$34.69 |
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: Central Health Plan Commercial |
$30.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.42
|
| Rate for Payer: Galaxy Health WC |
$32.76
|
| Rate for Payer: Global Benefits Group Commercial |
$23.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.71
|
| Rate for Payer: Multiplan Commercial |
$28.90
|
| Rate for Payer: Networks By Design Commercial |
$25.05
|
| Rate for Payer: Prime Health Services Commercial |
$32.76
|
|
|
HC DRSNG HYDROGEL MCKESSN 4X4" SQ
|
Facility
|
OP
|
$38.54
|
|
| Hospital Charge Code |
901698647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$34.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.77
|
| Rate for Payer: Blue Distinction Transplant |
$23.12
|
| Rate for Payer: Blue Shield of California Commercial |
$24.24
|
| Rate for Payer: Blue Shield of California EPN |
$18.85
|
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: Central Health Plan Commercial |
$30.83
|
| Rate for Payer: Cigna of CA HMO |
$24.67
|
| Rate for Payer: Cigna of CA PPO |
$28.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.76
|
| Rate for Payer: Dignity Health Media |
$32.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.42
|
| Rate for Payer: Galaxy Health WC |
$32.76
|
| Rate for Payer: Global Benefits Group Commercial |
$23.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.71
|
| Rate for Payer: Multiplan Commercial |
$28.90
|
| Rate for Payer: Networks By Design Commercial |
$25.05
|
| Rate for Payer: Prime Health Services Commercial |
$32.76
|
| Rate for Payer: Riverside University Health System MISP |
$15.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.27
|
| Rate for Payer: United Healthcare All Other HMO |
$19.27
|
| Rate for Payer: United Healthcare HMO Rider |
$19.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.76
|
| Rate for Payer: Vantage Medical Group Senior |
$32.76
|
|
|
HC DRSNG INTERDRY 10X36 IN SHEET
|
Facility
|
IP
|
$262.43
|
|
| Hospital Charge Code |
901607341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$236.19 |
| Rate for Payer: Cash Price |
$118.09
|
| Rate for Payer: Central Health Plan Commercial |
$209.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.97
|
| Rate for Payer: Galaxy Health WC |
$223.07
|
| Rate for Payer: Global Benefits Group Commercial |
$157.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.49
|
| Rate for Payer: Multiplan Commercial |
$196.82
|
| Rate for Payer: Networks By Design Commercial |
$170.58
|
| Rate for Payer: Prime Health Services Commercial |
$223.07
|
|
|
HC DRSNG INTERDRY 10X36 IN SHEET
|
Facility
|
OP
|
$262.43
|
|
| Hospital Charge Code |
901607341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$236.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$159.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.04
|
| Rate for Payer: Blue Distinction Transplant |
$157.46
|
| Rate for Payer: Blue Shield of California Commercial |
$165.07
|
| Rate for Payer: Blue Shield of California EPN |
$128.33
|
| Rate for Payer: Cash Price |
$118.09
|
| Rate for Payer: Central Health Plan Commercial |
$209.94
|
| Rate for Payer: Cigna of CA HMO |
$167.96
|
| Rate for Payer: Cigna of CA PPO |
$194.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.07
|
| Rate for Payer: Dignity Health Media |
$223.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$104.97
|
| Rate for Payer: Galaxy Health WC |
$223.07
|
| Rate for Payer: Global Benefits Group Commercial |
$157.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$236.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$196.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$91.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.49
|
| Rate for Payer: Multiplan Commercial |
$196.82
|
| Rate for Payer: Networks By Design Commercial |
$170.58
|
| Rate for Payer: Prime Health Services Commercial |
$223.07
|
| Rate for Payer: Riverside University Health System MISP |
$104.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.22
|
| Rate for Payer: United Healthcare All Other HMO |
$131.22
|
| Rate for Payer: United Healthcare HMO Rider |
$131.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.07
|
| Rate for Payer: Vantage Medical Group Senior |
$223.07
|
|
|
HC DRSNG IV TEGADERM BRDR 2X2.25"
|
Facility
|
IP
|
$2.38
|
|
| Hospital Charge Code |
901698417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
|
|
HC DRSNG IV TEGADERM BRDR 2X2.25"
|
Facility
|
OP
|
$2.38
|
|
| Hospital Charge Code |
901698417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Blue Distinction Transplant |
$1.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.16
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Central Health Plan Commercial |
$1.90
|
| Rate for Payer: Cigna of CA HMO |
$1.52
|
| Rate for Payer: Cigna of CA PPO |
$1.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.02
|
| Rate for Payer: Dignity Health Media |
$2.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.95
|
| Rate for Payer: Galaxy Health WC |
$2.02
|
| Rate for Payer: Global Benefits Group Commercial |
$1.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$1.78
|
| Rate for Payer: Networks By Design Commercial |
$1.55
|
| Rate for Payer: Prime Health Services Commercial |
$2.02
|
| Rate for Payer: Riverside University Health System MISP |
$0.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.19
|
| Rate for Payer: United Healthcare All Other HMO |
$1.19
|
| Rate for Payer: United Healthcare HMO Rider |
$1.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.02
|
| Rate for Payer: Vantage Medical Group Senior |
$2.02
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 1.75X1.75CM
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$1,043.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,043.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$454.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$303.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$332.78
|
| Rate for Payer: Blue Distinction Transplant |
$495.60
|
| Rate for Payer: Blue Shield of California Commercial |
$519.55
|
| Rate for Payer: Blue Shield of California EPN |
$403.91
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Central Health Plan Commercial |
$660.80
|
| Rate for Payer: Cigna of CA HMO |
$578.20
|
| Rate for Payer: Cigna of CA PPO |
$578.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.10
|
| Rate for Payer: Dignity Health Media |
$702.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$743.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$619.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: Networks By Design Commercial |
$413.00
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: Riverside University Health System MISP |
$330.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.00
|
| Rate for Payer: United Healthcare All Other HMO |
$413.00
|
| Rate for Payer: United Healthcare HMO Rider |
$413.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.10
|
| Rate for Payer: Vantage Medical Group Senior |
$702.10
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 1.75X1.75CM
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Blue Shield of California Commercial |
$619.50
|
| Rate for Payer: Blue Shield of California EPN |
$441.08
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Central Health Plan Commercial |
$660.80
|
| Rate for Payer: Cigna of CA HMO |
$578.20
|
| Rate for Payer: Cigna of CA PPO |
$578.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$743.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: Networks By Design Commercial |
$413.00
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$311.90
|
| Rate for Payer: United Healthcare All Other HMO |
$304.63
|
| Rate for Payer: United Healthcare HMO Rider |
$298.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.58
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 3 X 3.5CM
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Blue Shield of California Commercial |
$222.00
|
| Rate for Payer: Blue Shield of California EPN |
$158.06
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$148.00
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.77
|
| Rate for Payer: United Healthcare All Other HMO |
$109.16
|
| Rate for Payer: United Healthcare HMO Rider |
$106.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.68
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 3 X 3.5CM
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$1,043.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,043.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$303.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$332.78
|
| Rate for Payer: Blue Distinction Transplant |
$177.60
|
| Rate for Payer: Blue Shield of California Commercial |
$186.18
|
| Rate for Payer: Blue Shield of California EPN |
$144.74
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$251.60
|
| Rate for Payer: Dignity Health Media |
$251.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$222.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$103.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$148.00
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: Riverside University Health System MISP |
$118.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.00
|
| Rate for Payer: United Healthcare All Other HMO |
$148.00
|
| Rate for Payer: United Healthcare HMO Rider |
$148.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.60
|
| Rate for Payer: Vantage Medical Group Senior |
$251.60
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 3 X 7CM
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$1,043.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,043.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$303.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$332.78
|
| Rate for Payer: Blue Distinction Transplant |
$111.60
|
| Rate for Payer: Blue Shield of California Commercial |
$116.99
|
| Rate for Payer: Blue Shield of California EPN |
$90.95
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: Cigna of CA HMO |
$130.20
|
| Rate for Payer: Cigna of CA PPO |
$130.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.10
|
| Rate for Payer: Dignity Health Media |
$158.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$139.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$93.00
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: Riverside University Health System MISP |
$74.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.00
|
| Rate for Payer: United Healthcare All Other HMO |
$93.00
|
| Rate for Payer: United Healthcare HMO Rider |
$93.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.10
|
| Rate for Payer: Vantage Medical Group Senior |
$158.10
|
|
|
HC DRSNG KERECIS OMEGA 3 WOUND 3 X 7CM
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT Q4158
|
| Hospital Charge Code |
900102214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Blue Shield of California Commercial |
$139.50
|
| Rate for Payer: Blue Shield of California EPN |
$99.32
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Central Health Plan Commercial |
$148.80
|
| Rate for Payer: Cigna of CA HMO |
$130.20
|
| Rate for Payer: Cigna of CA PPO |
$130.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.20
|
| Rate for Payer: Multiplan Commercial |
$139.50
|
| Rate for Payer: Networks By Design Commercial |
$93.00
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.23
|
| Rate for Payer: United Healthcare All Other HMO |
$68.60
|
| Rate for Payer: United Healthcare HMO Rider |
$67.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.38
|
|
