|
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 |
$47.74 |
| Rate for Payer: Adventist Health Commercial |
$11.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.84
|
| 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 |
$42.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.49
|
| Rate for Payer: Cash Price |
$30.89
|
| 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 Medi-Cal |
$47.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.47
|
| Rate for Payer: EPIC Health Plan Senior |
$22.47
|
| Rate for Payer: Galaxy Health WC |
$47.74
|
| Rate for Payer: Global Benefits Group Commercial |
$33.70
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$34.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.32
|
| Rate for Payer: Multiplan Commercial |
$44.94
|
| Rate for Payer: Networks By Design Commercial |
$36.51
|
| Rate for Payer: Prime Health Services Commercial |
$47.74
|
| 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 |
$28.09
|
| Rate for Payer: United Healthcare All Other HMO |
$28.09
|
| Rate for Payer: United Healthcare HMO Rider |
$28.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.74
|
| 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 |
$47.74 |
| Rate for Payer: Adventist Health Commercial |
$11.23
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.47
|
| Rate for Payer: EPIC Health Plan Senior |
$22.47
|
| Rate for Payer: Galaxy Health WC |
$47.74
|
| Rate for Payer: Global Benefits Group Commercial |
$33.70
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$34.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.48
|
| Rate for Payer: Multiplan Commercial |
$44.94
|
| 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
|
$35.92
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901698329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Cash Price |
$19.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.37
|
| Rate for Payer: Galaxy Health WC |
$30.53
|
| Rate for Payer: Global Benefits Group Commercial |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$28.74
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
|
|
HC DRSNG HYDROGEL 2.4X2.4"
|
Facility
|
OP
|
$35.92
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901698329
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.06
|
| Rate for Payer: Cash Price |
$19.76
|
| Rate for Payer: Cigna of CA HMO |
$22.99
|
| Rate for Payer: Cigna of CA PPO |
$26.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.37
|
| Rate for Payer: Galaxy Health WC |
$30.53
|
| Rate for Payer: Global Benefits Group Commercial |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.14
|
| Rate for Payer: Multiplan Commercial |
$28.74
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.96
|
| Rate for Payer: United Healthcare HMO Rider |
$17.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.53
|
| Rate for Payer: Vantage Medical Group Senior |
$30.53
|
|
|
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 |
$32.76 |
| Rate for Payer: Adventist Health Commercial |
$7.71
|
| Rate for Payer: Cash Price |
$21.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.42
|
| Rate for Payer: EPIC Health Plan Senior |
$15.42
|
| Rate for Payer: Galaxy Health WC |
$32.76
|
| Rate for Payer: Global Benefits Group Commercial |
$23.12
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$23.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.25
|
| Rate for Payer: Multiplan Commercial |
$30.83
|
| 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 |
$32.76 |
| Rate for Payer: Adventist Health Commercial |
$7.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.28
|
| 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 |
$28.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.67
|
| Rate for Payer: Cash Price |
$21.20
|
| 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 Medi-Cal |
$32.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.42
|
| Rate for Payer: EPIC Health Plan Senior |
$15.42
|
| Rate for Payer: Galaxy Health WC |
$32.76
|
| Rate for Payer: Global Benefits Group Commercial |
$23.12
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$23.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.98
|
| Rate for Payer: Multiplan Commercial |
$30.83
|
| Rate for Payer: Networks By Design Commercial |
$25.05
|
| Rate for Payer: Prime Health Services Commercial |
$32.76
|
| 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 Commercial/Exchange |
$32.76
|
| 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
|
OP
|
$262.43
|
|
| Hospital Charge Code |
901607341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$223.07 |
| Rate for Payer: Adventist Health Commercial |
$52.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.13
|
| 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 |
$196.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.16
|
| Rate for Payer: Cash Price |
$144.34
|
| 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 Medi-Cal |
$223.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$223.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.97
|
| Rate for Payer: EPIC Health Plan Senior |
$104.97
|
| Rate for Payer: Galaxy Health WC |
$223.07
|
| Rate for Payer: Global Benefits Group Commercial |
$157.46
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$162.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$183.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.70
|
| Rate for Payer: Multiplan Commercial |
$209.94
|
| Rate for Payer: Networks By Design Commercial |
$170.58
|
| Rate for Payer: Prime Health Services Commercial |
$223.07
|
| 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 Commercial/Exchange |
$223.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.07
|
| Rate for Payer: Vantage Medical Group Senior |
$223.07
|
|
|
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 |
$223.07 |
| Rate for Payer: Adventist Health Commercial |
$52.49
|
| Rate for Payer: Cash Price |
$144.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.97
|
| Rate for Payer: EPIC Health Plan Senior |
$104.97
|
| Rate for Payer: Galaxy Health WC |
$223.07
|
| Rate for Payer: Global Benefits Group Commercial |
$157.46
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$162.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.98
|
| Rate for Payer: Multiplan Commercial |
$209.94
|
| Rate for Payer: Networks By Design Commercial |
$170.58
|
| Rate for Payer: Prime Health Services Commercial |
$223.07
|
|
|
HC DRSNG IV TEGADERM BRDR 2X2.25"
|
Facility
|
OP
|
$2.30
|
|
| Hospital Charge Code |
901698417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.41
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cigna of CA HMO |
$1.47
|
| Rate for Payer: Cigna of CA PPO |
$1.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.15
|
| Rate for Payer: United Healthcare All Other HMO |
$1.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1.96
|
|
|
HC DRSNG IV TEGADERM BRDR 2X2.25"
|
Facility
|
IP
|
$2.30
|
|
| Hospital Charge Code |
901698417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: Adventist Health Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.92
|
| Rate for Payer: EPIC Health Plan Senior |
$0.92
|
| Rate for Payer: Galaxy Health WC |
$1.96
|
| Rate for Payer: Global Benefits Group Commercial |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.84
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Prime Health Services Commercial |
$1.96
|
|
|
HC DRSNG MEDIPORE ADHSV 3-1/2"X6"
|
Facility
|
IP
|
$5.90
|
|
|
Service Code
|
CPT A6220
|
| Hospital Charge Code |
901698616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
|
|
HC DRSNG MEDIPORE ADHSV 3-1/2"X6"
|
Facility
|
OP
|
$5.90
|
|
|
Service Code
|
CPT A6220
|
| Hospital Charge Code |
901698616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.62
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
HC DRSNG MEPILEX 4X4
|
Facility
|
IP
|
$18.61
|
|
| Hospital Charge Code |
901602023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: Multiplan Commercial |
$14.89
|
| Rate for Payer: Networks By Design Commercial |
$12.10
|
| Rate for Payer: Prime Health Services Commercial |
$15.82
|
|
|
HC DRSNG MEPILEX 4X4
|
Facility
|
OP
|
$18.61
|
|
| Hospital Charge Code |
901602023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.43
|
| Rate for Payer: Cash Price |
$10.24
|
| Rate for Payer: Cigna of CA HMO |
$11.91
|
| Rate for Payer: Cigna of CA PPO |
$13.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.03
|
| Rate for Payer: Multiplan Commercial |
$14.89
|
| Rate for Payer: Networks By Design Commercial |
$12.10
|
| Rate for Payer: Prime Health Services Commercial |
$15.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO |
$9.30
|
| Rate for Payer: United Healthcare HMO Rider |
$9.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.82
|
|
|
HC DRSNG MEPILEX BORDER 3X3"
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$13.25
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
HC DRSNG MEPILEX BORDER 3X3"
|
Facility
|
OP
|
$16.56
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.17
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$13.25
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
HC DRSNG MEPILEX BORDER 4X10"
|
Facility
|
OP
|
$38.46
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$32.69 |
| Rate for Payer: Adventist Health Commercial |
$7.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.62
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$24.61
|
| Rate for Payer: Cigna of CA PPO |
$28.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Senior |
$15.38
|
| Rate for Payer: Galaxy Health WC |
$32.69
|
| Rate for Payer: Global Benefits Group Commercial |
$23.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.92
|
| Rate for Payer: Multiplan Commercial |
$30.77
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$32.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.23
|
| Rate for Payer: United Healthcare All Other HMO |
$19.23
|
| Rate for Payer: United Healthcare HMO Rider |
$19.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.69
|
| Rate for Payer: Vantage Medical Group Senior |
$32.69
|
|
|
HC DRSNG MEPILEX BORDER 4X10"
|
Facility
|
IP
|
$38.46
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$32.69 |
| Rate for Payer: Adventist Health Commercial |
$7.69
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Senior |
$15.38
|
| Rate for Payer: Galaxy Health WC |
$32.69
|
| Rate for Payer: Global Benefits Group Commercial |
$23.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$30.77
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$32.69
|
|
|
HC DRSNG MEPILEX BORDER 4X12"
|
Facility
|
IP
|
$39.11
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$33.24 |
| Rate for Payer: Adventist Health Commercial |
$7.82
|
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.64
|
| Rate for Payer: EPIC Health Plan Senior |
$15.64
|
| Rate for Payer: Galaxy Health WC |
$33.24
|
| Rate for Payer: Global Benefits Group Commercial |
$23.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.39
|
| Rate for Payer: Multiplan Commercial |
$31.29
|
| Rate for Payer: Networks By Design Commercial |
$25.42
|
| Rate for Payer: Prime Health Services Commercial |
$33.24
|
|
|
HC DRSNG MEPILEX BORDER 4X12"
|
Facility
|
OP
|
$39.11
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$33.24 |
| Rate for Payer: Adventist Health Commercial |
$7.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.02
|
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Cigna of CA HMO |
$25.03
|
| Rate for Payer: Cigna of CA PPO |
$28.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.64
|
| Rate for Payer: EPIC Health Plan Senior |
$15.64
|
| Rate for Payer: Galaxy Health WC |
$33.24
|
| Rate for Payer: Global Benefits Group Commercial |
$23.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.38
|
| Rate for Payer: Multiplan Commercial |
$31.29
|
| Rate for Payer: Networks By Design Commercial |
$25.42
|
| Rate for Payer: Prime Health Services Commercial |
$33.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.55
|
| Rate for Payer: United Healthcare All Other HMO |
$19.55
|
| Rate for Payer: United Healthcare HMO Rider |
$19.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.24
|
| Rate for Payer: Vantage Medical Group Senior |
$33.24
|
|
|
HC DRSNG MEPILEX BORDER 4X8"
|
Facility
|
IP
|
$35.51
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$30.18 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.18
|
| Rate for Payer: Global Benefits Group Commercial |
$21.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$28.41
|
| Rate for Payer: Networks By Design Commercial |
$23.08
|
| Rate for Payer: Prime Health Services Commercial |
$30.18
|
|
|
HC DRSNG MEPILEX BORDER 4X8"
|
Facility
|
OP
|
$35.51
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$30.18 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.81
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cigna of CA HMO |
$22.73
|
| Rate for Payer: Cigna of CA PPO |
$26.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.18
|
| Rate for Payer: Global Benefits Group Commercial |
$21.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.86
|
| Rate for Payer: Multiplan Commercial |
$28.41
|
| Rate for Payer: Networks By Design Commercial |
$23.08
|
| Rate for Payer: Prime Health Services Commercial |
$30.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.75
|
| Rate for Payer: United Healthcare All Other HMO |
$17.75
|
| Rate for Payer: United Healthcare HMO Rider |
$17.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.18
|
| Rate for Payer: Vantage Medical Group Senior |
$30.18
|
|
|
HC DRSNG MEPILEX BORDER 6X6"
|
Facility
|
OP
|
$38.38
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.57
|
| Rate for Payer: Cash Price |
$21.11
|
| Rate for Payer: Cigna of CA HMO |
$24.56
|
| Rate for Payer: Cigna of CA PPO |
$28.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Senior |
$15.35
|
| Rate for Payer: Galaxy Health WC |
$32.62
|
| Rate for Payer: Global Benefits Group Commercial |
$23.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$30.70
|
| Rate for Payer: Networks By Design Commercial |
$24.95
|
| Rate for Payer: Prime Health Services Commercial |
$32.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.19
|
| Rate for Payer: United Healthcare All Other HMO |
$19.19
|
| Rate for Payer: United Healthcare HMO Rider |
$19.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.62
|
| Rate for Payer: Vantage Medical Group Senior |
$32.62
|
|
|
HC DRSNG MEPILEX BORDER 6X6"
|
Facility
|
IP
|
$38.38
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$21.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Senior |
$15.35
|
| Rate for Payer: Galaxy Health WC |
$32.62
|
| Rate for Payer: Global Benefits Group Commercial |
$23.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$30.70
|
| Rate for Payer: Networks By Design Commercial |
$24.95
|
| Rate for Payer: Prime Health Services Commercial |
$32.62
|
|
|
HC DRSNG MEPILEX BORDER 6X8"
|
Facility
|
IP
|
$44.36
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$37.71 |
| Rate for Payer: Adventist Health Commercial |
$8.87
|
| Rate for Payer: Cash Price |
$24.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.74
|
| Rate for Payer: EPIC Health Plan Senior |
$17.74
|
| Rate for Payer: Galaxy Health WC |
$37.71
|
| Rate for Payer: Global Benefits Group Commercial |
$26.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.65
|
| Rate for Payer: Multiplan Commercial |
$35.49
|
| Rate for Payer: Networks By Design Commercial |
$28.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.71
|
|
