|
HC DRSNG VAC GAUZE ROLL LRG ANTIM
|
Facility
|
OP
|
$60.76
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$62.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.90
|
| Rate for Payer: Blue Distinction Transplant |
$36.46
|
| Rate for Payer: Blue Shield of California Commercial |
$38.22
|
| Rate for Payer: Blue Shield of California EPN |
$29.71
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Central Health Plan Commercial |
$48.61
|
| Rate for Payer: Cigna of CA HMO |
$38.89
|
| Rate for Payer: Cigna of CA PPO |
$44.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.65
|
| Rate for Payer: Dignity Health Media |
$51.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.30
|
| Rate for Payer: Galaxy Health WC |
$51.65
|
| Rate for Payer: Global Benefits Group Commercial |
$36.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.15
|
| Rate for Payer: Multiplan Commercial |
$45.57
|
| Rate for Payer: Networks By Design Commercial |
$39.49
|
| Rate for Payer: Prime Health Services Commercial |
$51.65
|
| Rate for Payer: Riverside University Health System MISP |
$24.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.38
|
| Rate for Payer: United Healthcare All Other HMO |
$30.38
|
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.65
|
| Rate for Payer: Vantage Medical Group Senior |
$51.65
|
|
|
HC DRSNG VAC GAUZE ROLL LRG ANTIM
|
Facility
|
IP
|
$60.76
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.15 |
| Max. Negotiated Rate |
$54.68 |
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Central Health Plan Commercial |
$48.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.30
|
| Rate for Payer: Galaxy Health WC |
$51.65
|
| Rate for Payer: Global Benefits Group Commercial |
$36.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.15
|
| Rate for Payer: Multiplan Commercial |
$45.57
|
| Rate for Payer: Networks By Design Commercial |
$39.49
|
| Rate for Payer: Prime Health Services Commercial |
$51.65
|
|
|
HC DRSNG VAC RESTORE AG 4X5
|
Facility
|
IP
|
$62.73
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901606110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$56.46 |
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Central Health Plan Commercial |
$50.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.09
|
| Rate for Payer: Galaxy Health WC |
$53.32
|
| Rate for Payer: Global Benefits Group Commercial |
$37.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$47.05
|
| Rate for Payer: Networks By Design Commercial |
$40.77
|
| Rate for Payer: Prime Health Services Commercial |
$53.32
|
|
|
HC DRSNG VAC RESTORE AG 4X5
|
Facility
|
OP
|
$62.73
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901606110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$56.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.06
|
| Rate for Payer: Blue Distinction Transplant |
$37.64
|
| Rate for Payer: Blue Shield of California Commercial |
$39.46
|
| Rate for Payer: Blue Shield of California EPN |
$30.67
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Cash Price |
$28.23
|
| Rate for Payer: Central Health Plan Commercial |
$50.18
|
| Rate for Payer: Cigna of CA HMO |
$40.15
|
| Rate for Payer: Cigna of CA PPO |
$46.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.32
|
| Rate for Payer: Dignity Health Media |
$53.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.09
|
| Rate for Payer: Galaxy Health WC |
$53.32
|
| Rate for Payer: Global Benefits Group Commercial |
$37.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.55
|
| Rate for Payer: Multiplan Commercial |
$47.05
|
| Rate for Payer: Networks By Design Commercial |
$40.77
|
| Rate for Payer: Prime Health Services Commercial |
$53.32
|
| Rate for Payer: Riverside University Health System MISP |
$25.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.36
|
| Rate for Payer: United Healthcare All Other HMO |
$31.36
|
| Rate for Payer: United Healthcare HMO Rider |
$31.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.32
|
| Rate for Payer: Vantage Medical Group Senior |
$53.32
|
|
|
HC DRSNG VAC VERAFLO CLEANSE MED
|
Facility
|
IP
|
$1,133.49
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.70 |
| Max. Negotiated Rate |
$1,020.14 |
| Rate for Payer: Cash Price |
$510.07
|
| Rate for Payer: Central Health Plan Commercial |
$906.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.40
|
| Rate for Payer: Galaxy Health WC |
$963.47
|
| Rate for Payer: Global Benefits Group Commercial |
$680.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,020.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$756.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.70
|
| Rate for Payer: Multiplan Commercial |
$850.12
|
| Rate for Payer: Networks By Design Commercial |
$736.77
|
| Rate for Payer: Prime Health Services Commercial |
$963.47
|
|
|
HC DRSNG VAC VERAFLO CLEANSE MED
|
Facility
|
OP
|
$1,133.49
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$1,020.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$963.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$623.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$623.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$548.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$669.67
|
| Rate for Payer: Blue Distinction Transplant |
$680.09
|
| Rate for Payer: Blue Shield of California Commercial |
$712.97
|
| Rate for Payer: Blue Shield of California EPN |
$554.28
|
| Rate for Payer: Cash Price |
$510.07
|
| Rate for Payer: Cash Price |
$510.07
|
| Rate for Payer: Central Health Plan Commercial |
$906.79
|
| Rate for Payer: Cigna of CA HMO |
$725.43
|
| Rate for Payer: Cigna of CA PPO |
$838.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$963.47
|
| Rate for Payer: Dignity Health Media |
$963.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$963.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$453.40
|
| Rate for Payer: Galaxy Health WC |
$963.47
|
| Rate for Payer: Global Benefits Group Commercial |
$680.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,020.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$850.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$396.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$756.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.70
|
| Rate for Payer: Multiplan Commercial |
$850.12
|
| Rate for Payer: Networks By Design Commercial |
$736.77
|
| Rate for Payer: Prime Health Services Commercial |
$963.47
|
| Rate for Payer: Riverside University Health System MISP |
$453.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$680.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$680.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$566.74
|
| Rate for Payer: United Healthcare All Other HMO |
$566.74
|
| Rate for Payer: United Healthcare HMO Rider |
$566.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$963.47
|
| Rate for Payer: Vantage Medical Group Senior |
$963.47
|
|
|
HC DRSNG WND ADHESV RENASYS GEL P
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.71
|
| Rate for Payer: Blue Distinction Transplant |
$25.09
|
| Rate for Payer: Blue Shield of California Commercial |
$26.30
|
| Rate for Payer: Blue Shield of California EPN |
$20.45
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Central Health Plan Commercial |
$33.46
|
| Rate for Payer: Cigna of CA HMO |
$26.76
|
| Rate for Payer: Cigna of CA PPO |
$30.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.55
|
| Rate for Payer: Dignity Health Media |
$35.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.73
|
| Rate for Payer: Galaxy Health WC |
$35.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$31.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.36
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.55
|
| Rate for Payer: Riverside University Health System MISP |
$16.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.55
|
| Rate for Payer: Vantage Medical Group Senior |
$35.55
|
|
|
HC DRSNG WND ADHESV RENASYS GEL P
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Cash Price |
$18.82
|
| Rate for Payer: Central Health Plan Commercial |
$33.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: Galaxy Health WC |
$35.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.36
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: Networks By Design Commercial |
$27.18
|
| Rate for Payer: Prime Health Services Commercial |
$35.55
|
|
|
HC DRSNG WOUND 3.6 X 8" MEDPORE
|
Facility
|
IP
|
$7.79
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901698618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Central Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
|
|
HC DRSNG WOUND 3.6 X 8" MEDPORE
|
Facility
|
OP
|
$7.79
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901698618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.60
|
| Rate for Payer: Blue Distinction Transplant |
$4.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4.90
|
| Rate for Payer: Blue Shield of California EPN |
$3.81
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Central Health Plan Commercial |
$6.23
|
| Rate for Payer: Cigna of CA HMO |
$4.99
|
| Rate for Payer: Cigna of CA PPO |
$5.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.62
|
| Rate for Payer: Dignity Health Media |
$6.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.01
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
| Rate for Payer: Riverside University Health System MISP |
$3.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.62
|
| Rate for Payer: Vantage Medical Group Senior |
$6.62
|
|
|
HC DRSNG WOUND ANASEPT GEL 3OZ
|
Facility
|
OP
|
$125.93
|
|
| Hospital Charge Code |
901698215
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.19 |
| Max. Negotiated Rate |
$113.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.40
|
| Rate for Payer: Blue Distinction Transplant |
$75.56
|
| Rate for Payer: Blue Shield of California Commercial |
$79.21
|
| Rate for Payer: Blue Shield of California EPN |
$61.58
|
| Rate for Payer: Cash Price |
$56.67
|
| Rate for Payer: Central Health Plan Commercial |
$100.74
|
| Rate for Payer: Cigna of CA HMO |
$80.60
|
| Rate for Payer: Cigna of CA PPO |
$93.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.04
|
| Rate for Payer: Dignity Health Media |
$107.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.37
|
| Rate for Payer: Galaxy Health WC |
$107.04
|
| Rate for Payer: Global Benefits Group Commercial |
$75.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$94.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.19
|
| Rate for Payer: Multiplan Commercial |
$94.45
|
| Rate for Payer: Networks By Design Commercial |
$81.85
|
| Rate for Payer: Prime Health Services Commercial |
$107.04
|
| Rate for Payer: Riverside University Health System MISP |
$50.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.96
|
| Rate for Payer: United Healthcare All Other HMO |
$62.96
|
| Rate for Payer: United Healthcare HMO Rider |
$62.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.04
|
| Rate for Payer: Vantage Medical Group Senior |
$107.04
|
|
|
HC DRSNG WOUND ANASEPT GEL 3OZ
|
Facility
|
IP
|
$125.93
|
|
| Hospital Charge Code |
901698215
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.19 |
| Max. Negotiated Rate |
$113.34 |
| Rate for Payer: Cash Price |
$56.67
|
| Rate for Payer: Central Health Plan Commercial |
$100.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.37
|
| Rate for Payer: Galaxy Health WC |
$107.04
|
| Rate for Payer: Global Benefits Group Commercial |
$75.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.19
|
| Rate for Payer: Multiplan Commercial |
$94.45
|
| Rate for Payer: Networks By Design Commercial |
$81.85
|
| Rate for Payer: Prime Health Services Commercial |
$107.04
|
|
|
HC DRSNG WOUND BIOPATCH 2CM/4MM
|
Facility
|
OP
|
$50.76
|
|
| Hospital Charge Code |
901605126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.99
|
| Rate for Payer: Blue Distinction Transplant |
$30.46
|
| Rate for Payer: Blue Shield of California Commercial |
$31.93
|
| Rate for Payer: Blue Shield of California EPN |
$24.82
|
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Central Health Plan Commercial |
$40.61
|
| Rate for Payer: Cigna of CA HMO |
$32.49
|
| Rate for Payer: Cigna of CA PPO |
$37.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.15
|
| Rate for Payer: Dignity Health Media |
$43.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$43.15
|
| Rate for Payer: Global Benefits Group Commercial |
$30.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$38.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.15
|
| Rate for Payer: Multiplan Commercial |
$38.07
|
| Rate for Payer: Networks By Design Commercial |
$32.99
|
| Rate for Payer: Prime Health Services Commercial |
$43.15
|
| Rate for Payer: Riverside University Health System MISP |
$20.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.38
|
| Rate for Payer: United Healthcare All Other HMO |
$25.38
|
| Rate for Payer: United Healthcare HMO Rider |
$25.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.15
|
| Rate for Payer: Vantage Medical Group Senior |
$43.15
|
|
|
HC DRSNG WOUND BIOPATCH 2CM/4MM
|
Facility
|
IP
|
$50.76
|
|
| Hospital Charge Code |
901605126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Central Health Plan Commercial |
$40.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$43.15
|
| Rate for Payer: Global Benefits Group Commercial |
$30.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.15
|
| Rate for Payer: Multiplan Commercial |
$38.07
|
| Rate for Payer: Networks By Design Commercial |
$32.99
|
| Rate for Payer: Prime Health Services Commercial |
$43.15
|
|
|
HC DRSNG WOUND ES PLUS AG RIBBON
|
Facility
|
IP
|
$74.78
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901698127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$67.30 |
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Central Health Plan Commercial |
$59.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Multiplan Commercial |
$56.08
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
|
|
HC DRSNG WOUND ES PLUS AG RIBBON
|
Facility
|
OP
|
$74.78
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901698127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$67.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.18
|
| Rate for Payer: Blue Distinction Transplant |
$44.87
|
| Rate for Payer: Blue Shield of California Commercial |
$47.04
|
| Rate for Payer: Blue Shield of California EPN |
$36.57
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Central Health Plan Commercial |
$59.82
|
| Rate for Payer: Cigna of CA HMO |
$47.86
|
| Rate for Payer: Cigna of CA PPO |
$55.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.56
|
| Rate for Payer: Dignity Health Media |
$63.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$56.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Multiplan Commercial |
$56.08
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
| Rate for Payer: Riverside University Health System MISP |
$29.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.39
|
| Rate for Payer: United Healthcare All Other HMO |
$37.39
|
| Rate for Payer: United Healthcare HMO Rider |
$37.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.56
|
| Rate for Payer: Vantage Medical Group Senior |
$63.56
|
|
|
HC DRSNG WOUND INTERDRY
|
Facility
|
IP
|
$338.45
|
|
| Hospital Charge Code |
901605294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$304.60 |
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Central Health Plan Commercial |
$270.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.38
|
| Rate for Payer: Galaxy Health WC |
$287.68
|
| Rate for Payer: Global Benefits Group Commercial |
$203.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$304.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.69
|
| Rate for Payer: Multiplan Commercial |
$253.84
|
| Rate for Payer: Networks By Design Commercial |
$219.99
|
| Rate for Payer: Prime Health Services Commercial |
$287.68
|
|
|
HC DRSNG WOUND INTERDRY
|
Facility
|
OP
|
$338.45
|
|
| Hospital Charge Code |
901605294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$304.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$205.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$287.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.96
|
| Rate for Payer: Blue Distinction Transplant |
$203.07
|
| Rate for Payer: Blue Shield of California Commercial |
$212.89
|
| Rate for Payer: Blue Shield of California EPN |
$165.50
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Central Health Plan Commercial |
$270.76
|
| Rate for Payer: Cigna of CA HMO |
$216.61
|
| Rate for Payer: Cigna of CA PPO |
$250.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$287.68
|
| Rate for Payer: Dignity Health Media |
$287.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$287.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$135.38
|
| Rate for Payer: Galaxy Health WC |
$287.68
|
| Rate for Payer: Global Benefits Group Commercial |
$203.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$304.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$253.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.69
|
| Rate for Payer: Multiplan Commercial |
$253.84
|
| Rate for Payer: Networks By Design Commercial |
$219.99
|
| Rate for Payer: Prime Health Services Commercial |
$287.68
|
| Rate for Payer: Riverside University Health System MISP |
$135.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.22
|
| Rate for Payer: United Healthcare All Other HMO |
$169.22
|
| Rate for Payer: United Healthcare HMO Rider |
$169.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$169.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$287.68
|
| Rate for Payer: Vantage Medical Group Senior |
$287.68
|
|
|
HC DRSNG WOUND MEPILEX 8X8"
|
Facility
|
IP
|
$210.84
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901695705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$189.76 |
| Rate for Payer: Cash Price |
$94.88
|
| Rate for Payer: Central Health Plan Commercial |
$168.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.34
|
| Rate for Payer: Galaxy Health WC |
$179.21
|
| Rate for Payer: Global Benefits Group Commercial |
$126.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.17
|
| Rate for Payer: Multiplan Commercial |
$158.13
|
| Rate for Payer: Networks By Design Commercial |
$137.05
|
| Rate for Payer: Prime Health Services Commercial |
$179.21
|
|
|
HC DRSNG WOUND MEPILEX 8X8"
|
Facility
|
OP
|
$210.84
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901695705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$189.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$179.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.56
|
| Rate for Payer: Blue Distinction Transplant |
$126.50
|
| Rate for Payer: Blue Shield of California Commercial |
$132.62
|
| Rate for Payer: Blue Shield of California EPN |
$103.10
|
| Rate for Payer: Cash Price |
$94.88
|
| Rate for Payer: Cash Price |
$94.88
|
| Rate for Payer: Central Health Plan Commercial |
$168.67
|
| Rate for Payer: Cigna of CA HMO |
$134.94
|
| Rate for Payer: Cigna of CA PPO |
$156.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$179.21
|
| Rate for Payer: Dignity Health Media |
$179.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$179.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.34
|
| Rate for Payer: Galaxy Health WC |
$179.21
|
| Rate for Payer: Global Benefits Group Commercial |
$126.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$158.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.17
|
| Rate for Payer: Multiplan Commercial |
$158.13
|
| Rate for Payer: Networks By Design Commercial |
$137.05
|
| Rate for Payer: Prime Health Services Commercial |
$179.21
|
| Rate for Payer: Riverside University Health System MISP |
$84.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.42
|
| Rate for Payer: United Healthcare All Other HMO |
$105.42
|
| Rate for Payer: United Healthcare HMO Rider |
$105.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$179.21
|
| Rate for Payer: Vantage Medical Group Senior |
$179.21
|
|
|
HC DRSNG WOUND MEPORE 3.5"X6"
|
Facility
|
OP
|
$3.28
|
|
| Hospital Charge Code |
901604798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.94
|
| Rate for Payer: Blue Distinction Transplant |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.79
|
| Rate for Payer: Dignity Health Media |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Riverside University Health System MISP |
$1.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.79
|
|
|
HC DRSNG WOUND MEPORE 3.5"X6"
|
Facility
|
IP
|
$3.28
|
|
| Hospital Charge Code |
901604798
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
|
|
HC DRSNG WOUND NON-ADHSV 6.125X8"
|
Facility
|
IP
|
$84.74
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901607859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$76.27 |
| Rate for Payer: Cash Price |
$38.13
|
| Rate for Payer: Central Health Plan Commercial |
$67.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.90
|
| Rate for Payer: Galaxy Health WC |
$72.03
|
| Rate for Payer: Global Benefits Group Commercial |
$50.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.95
|
| Rate for Payer: Multiplan Commercial |
$63.56
|
| Rate for Payer: Networks By Design Commercial |
$55.08
|
| Rate for Payer: Prime Health Services Commercial |
$72.03
|
|
|
HC DRSNG WOUND NON-ADHSV 6.125X8"
|
Facility
|
OP
|
$84.74
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901607859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$122.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.06
|
| Rate for Payer: Blue Distinction Transplant |
$50.84
|
| Rate for Payer: Blue Shield of California Commercial |
$53.30
|
| Rate for Payer: Blue Shield of California EPN |
$41.44
|
| Rate for Payer: Cash Price |
$38.13
|
| Rate for Payer: Cash Price |
$38.13
|
| Rate for Payer: Central Health Plan Commercial |
$67.79
|
| Rate for Payer: Cigna of CA HMO |
$54.23
|
| Rate for Payer: Cigna of CA PPO |
$62.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.03
|
| Rate for Payer: Dignity Health Media |
$72.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.90
|
| Rate for Payer: Galaxy Health WC |
$72.03
|
| Rate for Payer: Global Benefits Group Commercial |
$50.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$63.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.95
|
| Rate for Payer: Multiplan Commercial |
$63.56
|
| Rate for Payer: Networks By Design Commercial |
$55.08
|
| Rate for Payer: Prime Health Services Commercial |
$72.03
|
| Rate for Payer: Riverside University Health System MISP |
$33.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.37
|
| Rate for Payer: United Healthcare All Other HMO |
$42.37
|
| Rate for Payer: United Healthcare HMO Rider |
$42.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.03
|
| Rate for Payer: Vantage Medical Group Senior |
$72.03
|
|
|
HC DRSNG WOUND VAC ATS SMALL
|
Facility
|
OP
|
$230.30
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$207.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.06
|
| Rate for Payer: Blue Distinction Transplant |
$138.18
|
| Rate for Payer: Blue Shield of California Commercial |
$144.86
|
| Rate for Payer: Blue Shield of California EPN |
$112.62
|
| Rate for Payer: Cash Price |
$103.64
|
| Rate for Payer: Cash Price |
$103.64
|
| Rate for Payer: Central Health Plan Commercial |
$184.24
|
| Rate for Payer: Cigna of CA HMO |
$147.39
|
| Rate for Payer: Cigna of CA PPO |
$170.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.76
|
| Rate for Payer: Dignity Health Media |
$195.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$92.12
|
| Rate for Payer: Galaxy Health WC |
$195.76
|
| Rate for Payer: Global Benefits Group Commercial |
$138.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$172.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.06
|
| Rate for Payer: Multiplan Commercial |
$172.72
|
| Rate for Payer: Networks By Design Commercial |
$149.70
|
| Rate for Payer: Prime Health Services Commercial |
$195.76
|
| Rate for Payer: Riverside University Health System MISP |
$92.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.15
|
| Rate for Payer: United Healthcare All Other HMO |
$115.15
|
| Rate for Payer: United Healthcare HMO Rider |
$115.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.76
|
| Rate for Payer: Vantage Medical Group Senior |
$195.76
|
|
