|
HC DRSNG POLYM OVAL #5, 3X2" SLCN
|
Facility
|
OP
|
$24.44
|
|
| Hospital Charge Code |
901698350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.44
|
| Rate for Payer: Blue Distinction Transplant |
$14.66
|
| Rate for Payer: Blue Shield of California Commercial |
$15.37
|
| Rate for Payer: Blue Shield of California EPN |
$11.95
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$19.55
|
| Rate for Payer: Cigna of CA HMO |
$15.64
|
| Rate for Payer: Cigna of CA PPO |
$18.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.77
|
| Rate for Payer: Dignity Health Media |
$20.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.78
|
| Rate for Payer: Galaxy Health WC |
$20.77
|
| Rate for Payer: Global Benefits Group Commercial |
$14.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$18.33
|
| Rate for Payer: Networks By Design Commercial |
$15.89
|
| Rate for Payer: Prime Health Services Commercial |
$20.77
|
| Rate for Payer: Riverside University Health System MISP |
$9.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.22
|
| Rate for Payer: United Healthcare All Other HMO |
$12.22
|
| Rate for Payer: United Healthcare HMO Rider |
$12.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.77
|
| Rate for Payer: Vantage Medical Group Senior |
$20.77
|
|
|
HC DRSNG POLYM OVAL #5, 3X2" SLCN
|
Facility
|
IP
|
$24.44
|
|
| Hospital Charge Code |
901698350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.78
|
| Rate for Payer: Galaxy Health WC |
$20.77
|
| Rate for Payer: Global Benefits Group Commercial |
$14.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.89
|
| Rate for Payer: Multiplan Commercial |
$18.33
|
| Rate for Payer: Networks By Design Commercial |
$15.89
|
| Rate for Payer: Prime Health Services Commercial |
$20.77
|
|
|
HC DRSNG PRIMAPORE 8 X 4"
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901604508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$4.16
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
|
|
HC DRSNG PRIMAPORE 8 X 4"
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901604508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.78
|
| Rate for Payer: Blue Distinction Transplant |
$3.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.13
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$5.12
|
| Rate for Payer: Cigna of CA HMO |
$4.10
|
| Rate for Payer: Cigna of CA PPO |
$4.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.44
|
| Rate for Payer: Dignity Health Media |
$5.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$4.16
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
| Rate for Payer: Riverside University Health System MISP |
$2.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$5.44
|
|
|
HC DRSNG QUICKCLOT HEMO 4X4"
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
901698425
|
|
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 QUICKCLOT HEMO 4X4"
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
901698425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$92.31
|
| 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: 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 QUICKCLOT Z-FOLD
|
Facility
|
IP
|
$315.07
|
|
| Hospital Charge Code |
901608008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.01 |
| Max. Negotiated Rate |
$283.56 |
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Central Health Plan Commercial |
$252.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.03
|
| Rate for Payer: Galaxy Health WC |
$267.81
|
| Rate for Payer: Global Benefits Group Commercial |
$189.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.01
|
| Rate for Payer: Multiplan Commercial |
$236.30
|
| Rate for Payer: Networks By Design Commercial |
$204.80
|
| Rate for Payer: Prime Health Services Commercial |
$267.81
|
|
|
HC DRSNG QUICKCLOT Z-FOLD
|
Facility
|
OP
|
$315.07
|
|
| Hospital Charge Code |
901608008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.01 |
| Max. Negotiated Rate |
$283.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$191.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$152.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.14
|
| Rate for Payer: Blue Distinction Transplant |
$189.04
|
| Rate for Payer: Blue Shield of California Commercial |
$198.18
|
| Rate for Payer: Blue Shield of California EPN |
$154.07
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Central Health Plan Commercial |
$252.06
|
| Rate for Payer: Cigna of CA HMO |
$201.64
|
| Rate for Payer: Cigna of CA PPO |
$233.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.81
|
| Rate for Payer: Dignity Health Media |
$267.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$126.03
|
| Rate for Payer: Galaxy Health WC |
$267.81
|
| Rate for Payer: Global Benefits Group Commercial |
$189.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$283.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$236.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.01
|
| Rate for Payer: Multiplan Commercial |
$236.30
|
| Rate for Payer: Networks By Design Commercial |
$204.80
|
| Rate for Payer: Prime Health Services Commercial |
$267.81
|
| Rate for Payer: Riverside University Health System MISP |
$126.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.54
|
| Rate for Payer: United Healthcare All Other HMO |
$157.54
|
| Rate for Payer: United Healthcare HMO Rider |
$157.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.81
|
| Rate for Payer: Vantage Medical Group Senior |
$267.81
|
|
|
HC DRSNG RENASYS ABD KIT
|
Facility
|
IP
|
$224.70
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$202.23 |
| Rate for Payer: Cash Price |
$101.12
|
| Rate for Payer: Central Health Plan Commercial |
$179.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.88
|
| Rate for Payer: Galaxy Health WC |
$191.00
|
| Rate for Payer: Global Benefits Group Commercial |
$134.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.94
|
| Rate for Payer: Multiplan Commercial |
$168.52
|
| Rate for Payer: Networks By Design Commercial |
$146.06
|
| Rate for Payer: Prime Health Services Commercial |
$191.00
|
|
|
HC DRSNG RENASYS ABD KIT
|
Facility
|
OP
|
$224.70
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$202.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.75
|
| Rate for Payer: Blue Distinction Transplant |
$134.82
|
| Rate for Payer: Blue Shield of California Commercial |
$141.34
|
| Rate for Payer: Blue Shield of California EPN |
$109.88
|
| Rate for Payer: Cash Price |
$101.12
|
| Rate for Payer: Cash Price |
$101.12
|
| Rate for Payer: Central Health Plan Commercial |
$179.76
|
| Rate for Payer: Cigna of CA HMO |
$143.81
|
| Rate for Payer: Cigna of CA PPO |
$166.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.00
|
| Rate for Payer: Dignity Health Media |
$191.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$89.88
|
| Rate for Payer: Galaxy Health WC |
$191.00
|
| Rate for Payer: Global Benefits Group Commercial |
$134.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.94
|
| Rate for Payer: Multiplan Commercial |
$168.52
|
| Rate for Payer: Networks By Design Commercial |
$146.06
|
| Rate for Payer: Prime Health Services Commercial |
$191.00
|
| Rate for Payer: Riverside University Health System MISP |
$89.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.35
|
| Rate for Payer: United Healthcare All Other HMO |
$112.35
|
| Rate for Payer: United Healthcare HMO Rider |
$112.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.00
|
| Rate for Payer: Vantage Medical Group Senior |
$191.00
|
|
|
HC DRSNG RENASYS F-FOAM LG KIT
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| 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 |
$39.90
|
| 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 RENASYS F-FOAM LG KIT
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: 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 RENSASYS F-FOAM SM KIT
|
Facility
|
IP
|
$47.48
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Central Health Plan Commercial |
$37.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$35.61
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
|
|
HC DRSNG RENSASYS F-FOAM SM KIT
|
Facility
|
OP
|
$47.48
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$62.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.05
|
| Rate for Payer: Blue Distinction Transplant |
$28.49
|
| Rate for Payer: Blue Shield of California Commercial |
$29.86
|
| Rate for Payer: Blue Shield of California EPN |
$23.22
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Central Health Plan Commercial |
$37.98
|
| Rate for Payer: Cigna of CA HMO |
$30.39
|
| Rate for Payer: Cigna of CA PPO |
$35.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.36
|
| Rate for Payer: Dignity Health Media |
$40.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$35.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$35.61
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
| Rate for Payer: Riverside University Health System MISP |
$18.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.74
|
| Rate for Payer: United Healthcare All Other HMO |
$23.74
|
| Rate for Payer: United Healthcare HMO Rider |
$23.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.36
|
| Rate for Payer: Vantage Medical Group Senior |
$40.36
|
|
|
HC DRSNG SHEET 4X5 HD THERAHONEY
|
Facility
|
OP
|
$69.95
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.33
|
| Rate for Payer: Blue Distinction Transplant |
$41.97
|
| Rate for Payer: Blue Shield of California Commercial |
$44.00
|
| Rate for Payer: Blue Shield of California EPN |
$34.21
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: Central Health Plan Commercial |
$55.96
|
| Rate for Payer: Cigna of CA HMO |
$44.77
|
| Rate for Payer: Cigna of CA PPO |
$51.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.46
|
| Rate for Payer: Dignity Health Media |
$59.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.98
|
| Rate for Payer: Galaxy Health WC |
$59.46
|
| Rate for Payer: Global Benefits Group Commercial |
$41.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$52.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.99
|
| Rate for Payer: Multiplan Commercial |
$52.46
|
| Rate for Payer: Networks By Design Commercial |
$45.47
|
| Rate for Payer: Prime Health Services Commercial |
$59.46
|
| Rate for Payer: Riverside University Health System MISP |
$27.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.98
|
| Rate for Payer: United Healthcare All Other HMO |
$34.98
|
| Rate for Payer: United Healthcare HMO Rider |
$34.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.46
|
| Rate for Payer: Vantage Medical Group Senior |
$59.46
|
|
|
HC DRSNG SHEET 4X5 HD THERAHONEY
|
Facility
|
IP
|
$69.95
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Cash Price |
$31.48
|
| Rate for Payer: Central Health Plan Commercial |
$55.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.98
|
| Rate for Payer: Galaxy Health WC |
$59.46
|
| Rate for Payer: Global Benefits Group Commercial |
$41.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.99
|
| Rate for Payer: Multiplan Commercial |
$52.46
|
| Rate for Payer: Networks By Design Commercial |
$45.47
|
| Rate for Payer: Prime Health Services Commercial |
$59.46
|
|
|
HC DRSNG SILVASORB SITE 1.75 HRTM
|
Facility
|
OP
|
$50.59
|
|
| Hospital Charge Code |
901692017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.89
|
| Rate for Payer: Blue Distinction Transplant |
$30.35
|
| Rate for Payer: Blue Shield of California Commercial |
$31.82
|
| Rate for Payer: Blue Shield of California EPN |
$24.74
|
| Rate for Payer: Cash Price |
$22.77
|
| Rate for Payer: Central Health Plan Commercial |
$40.47
|
| Rate for Payer: Cigna of CA HMO |
$32.38
|
| Rate for Payer: Cigna of CA PPO |
$37.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.00
|
| Rate for Payer: Dignity Health Media |
$43.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$43.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$37.94
|
| Rate for Payer: Networks By Design Commercial |
$32.88
|
| Rate for Payer: Prime Health Services Commercial |
$43.00
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.30
|
| Rate for Payer: United Healthcare All Other HMO |
$25.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.00
|
| Rate for Payer: Vantage Medical Group Senior |
$43.00
|
|
|
HC DRSNG SILVASORB SITE 1.75 HRTM
|
Facility
|
IP
|
$50.59
|
|
| Hospital Charge Code |
901692017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Cash Price |
$22.77
|
| Rate for Payer: Central Health Plan Commercial |
$40.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$43.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$37.94
|
| Rate for Payer: Networks By Design Commercial |
$32.88
|
| Rate for Payer: Prime Health Services Commercial |
$43.00
|
|
|
HC DRSNG SILVER RESTORE 6X8 IN
|
Facility
|
OP
|
$118.64
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.27 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.09
|
| Rate for Payer: Blue Distinction Transplant |
$71.18
|
| Rate for Payer: Blue Shield of California Commercial |
$74.62
|
| Rate for Payer: Blue Shield of California EPN |
$58.01
|
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Central Health Plan Commercial |
$94.91
|
| Rate for Payer: Cigna of CA HMO |
$75.93
|
| Rate for Payer: Cigna of CA PPO |
$87.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.84
|
| Rate for Payer: Dignity Health Media |
$100.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.46
|
| Rate for Payer: Galaxy Health WC |
$100.84
|
| Rate for Payer: Global Benefits Group Commercial |
$71.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$88.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.73
|
| Rate for Payer: Multiplan Commercial |
$88.98
|
| Rate for Payer: Networks By Design Commercial |
$77.12
|
| Rate for Payer: Prime Health Services Commercial |
$100.84
|
| Rate for Payer: Riverside University Health System MISP |
$47.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.32
|
| Rate for Payer: United Healthcare All Other HMO |
$59.32
|
| Rate for Payer: United Healthcare HMO Rider |
$59.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.84
|
| Rate for Payer: Vantage Medical Group Senior |
$100.84
|
|
|
HC DRSNG SILVER RESTORE 6X8 IN
|
Facility
|
IP
|
$118.64
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.73 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Central Health Plan Commercial |
$94.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.46
|
| Rate for Payer: Galaxy Health WC |
$100.84
|
| Rate for Payer: Global Benefits Group Commercial |
$71.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.73
|
| Rate for Payer: Multiplan Commercial |
$88.98
|
| Rate for Payer: Networks By Design Commercial |
$77.12
|
| Rate for Payer: Prime Health Services Commercial |
$100.84
|
|
|
HC DRSNG SILVRCEL ALGINATE 1X12"
|
Facility
|
OP
|
$45.10
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.65
|
| Rate for Payer: Blue Distinction Transplant |
$27.06
|
| Rate for Payer: Blue Shield of California Commercial |
$28.37
|
| Rate for Payer: Blue Shield of California EPN |
$22.05
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.08
|
| Rate for Payer: Cigna of CA HMO |
$28.86
|
| Rate for Payer: Cigna of CA PPO |
$33.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.34
|
| Rate for Payer: Dignity Health Media |
$38.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.04
|
| Rate for Payer: Galaxy Health WC |
$38.34
|
| Rate for Payer: Global Benefits Group Commercial |
$27.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$33.82
|
| Rate for Payer: Networks By Design Commercial |
$29.32
|
| Rate for Payer: Prime Health Services Commercial |
$38.34
|
| Rate for Payer: Riverside University Health System MISP |
$18.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.55
|
| Rate for Payer: United Healthcare All Other HMO |
$22.55
|
| Rate for Payer: United Healthcare HMO Rider |
$22.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.34
|
| Rate for Payer: Vantage Medical Group Senior |
$38.34
|
|
|
HC DRSNG SILVRCEL ALGINATE 1X12"
|
Facility
|
IP
|
$45.10
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Central Health Plan Commercial |
$36.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: Galaxy Health WC |
$38.34
|
| Rate for Payer: Global Benefits Group Commercial |
$27.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$33.82
|
| Rate for Payer: Networks By Design Commercial |
$29.32
|
| Rate for Payer: Prime Health Services Commercial |
$38.34
|
|
|
HC DRSNG SLVR ALGINATE 4"X4.75"
|
Facility
|
OP
|
$44.03
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$43.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.01
|
| Rate for Payer: Blue Distinction Transplant |
$26.42
|
| Rate for Payer: Blue Shield of California Commercial |
$27.69
|
| Rate for Payer: Blue Shield of California EPN |
$21.53
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$35.22
|
| Rate for Payer: Cigna of CA HMO |
$28.18
|
| Rate for Payer: Cigna of CA PPO |
$32.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.43
|
| Rate for Payer: Dignity Health Media |
$37.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.63
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$33.02
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
| Rate for Payer: Riverside University Health System MISP |
$17.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.02
|
| Rate for Payer: United Healthcare All Other HMO |
$22.02
|
| Rate for Payer: United Healthcare HMO Rider |
$22.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.43
|
| Rate for Payer: Vantage Medical Group Senior |
$37.43
|
|
|
HC DRSNG SLVR ALGINATE 4"X4.75"
|
Facility
|
IP
|
$44.03
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$35.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$33.02
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
|
|
HC DRSNG SLVR AQUACEL AG 3.5X8"
|
Facility
|
OP
|
$241.57
|
|
| Hospital Charge Code |
901698804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.31 |
| Max. Negotiated Rate |
$217.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.72
|
| Rate for Payer: Blue Distinction Transplant |
$144.94
|
| Rate for Payer: Blue Shield of California Commercial |
$151.95
|
| Rate for Payer: Blue Shield of California EPN |
$118.13
|
| Rate for Payer: Cash Price |
$108.71
|
| Rate for Payer: Central Health Plan Commercial |
$193.26
|
| Rate for Payer: Cigna of CA HMO |
$154.60
|
| Rate for Payer: Cigna of CA PPO |
$178.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.33
|
| Rate for Payer: Dignity Health Media |
$205.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.63
|
| Rate for Payer: Galaxy Health WC |
$205.33
|
| Rate for Payer: Global Benefits Group Commercial |
$144.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$181.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.31
|
| Rate for Payer: Multiplan Commercial |
$181.18
|
| Rate for Payer: Networks By Design Commercial |
$157.02
|
| Rate for Payer: Prime Health Services Commercial |
$205.33
|
| Rate for Payer: Riverside University Health System MISP |
$96.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.78
|
| Rate for Payer: United Healthcare All Other HMO |
$120.78
|
| Rate for Payer: United Healthcare HMO Rider |
$120.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.33
|
| Rate for Payer: Vantage Medical Group Senior |
$205.33
|
|
