|
HC DRSNG MEPILEX TRANSFER AG 8X8
|
Facility
|
OP
|
$256.69
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901607630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.34 |
| Max. Negotiated Rate |
$218.19 |
| Rate for Payer: Adventist Health Commercial |
$51.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$218.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$141.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.63
|
| Rate for Payer: Cash Price |
$141.18
|
| Rate for Payer: Cigna of CA HMO |
$164.28
|
| Rate for Payer: Cigna of CA PPO |
$189.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$218.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$218.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.68
|
| Rate for Payer: EPIC Health Plan Senior |
$102.68
|
| Rate for Payer: Galaxy Health WC |
$218.19
|
| Rate for Payer: Global Benefits Group Commercial |
$154.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$171.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$179.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$179.68
|
| Rate for Payer: Multiplan Commercial |
$205.35
|
| Rate for Payer: Networks By Design Commercial |
$166.85
|
| Rate for Payer: Prime Health Services Commercial |
$218.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$154.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$154.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.34
|
| Rate for Payer: United Healthcare All Other HMO |
$128.34
|
| Rate for Payer: United Healthcare HMO Rider |
$128.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$218.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.19
|
| Rate for Payer: Vantage Medical Group Senior |
$218.19
|
|
|
HC DRSNG MEPILEX TRANSFER AG 8X8
|
Facility
|
IP
|
$256.69
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901607630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.34 |
| Max. Negotiated Rate |
$218.19 |
| Rate for Payer: Adventist Health Commercial |
$51.34
|
| Rate for Payer: Cash Price |
$141.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.68
|
| Rate for Payer: EPIC Health Plan Senior |
$102.68
|
| Rate for Payer: Galaxy Health WC |
$218.19
|
| Rate for Payer: Global Benefits Group Commercial |
$154.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$171.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.61
|
| Rate for Payer: Multiplan Commercial |
$205.35
|
| Rate for Payer: Networks By Design Commercial |
$166.85
|
| Rate for Payer: Prime Health Services Commercial |
$218.19
|
|
|
HC DRSNG MEPITEL 1 NON-ADH 4X7"
|
Facility
|
IP
|
$62.16
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$52.84 |
| Rate for Payer: Adventist Health Commercial |
$12.43
|
| Rate for Payer: Cash Price |
$34.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.86
|
| Rate for Payer: EPIC Health Plan Senior |
$24.86
|
| Rate for Payer: Galaxy Health WC |
$52.84
|
| Rate for Payer: Global Benefits Group Commercial |
$37.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.92
|
| Rate for Payer: Multiplan Commercial |
$49.73
|
| Rate for Payer: Networks By Design Commercial |
$40.40
|
| Rate for Payer: Prime Health Services Commercial |
$52.84
|
|
|
HC DRSNG MEPITEL 1 NON-ADH 4X7"
|
Facility
|
OP
|
$62.16
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$52.84 |
| Rate for Payer: Adventist Health Commercial |
$12.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.17
|
| Rate for Payer: Cash Price |
$34.19
|
| Rate for Payer: Cigna of CA HMO |
$39.78
|
| Rate for Payer: Cigna of CA PPO |
$46.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.86
|
| Rate for Payer: EPIC Health Plan Senior |
$24.86
|
| Rate for Payer: Galaxy Health WC |
$52.84
|
| Rate for Payer: Global Benefits Group Commercial |
$37.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.51
|
| Rate for Payer: Multiplan Commercial |
$49.73
|
| Rate for Payer: Networks By Design Commercial |
$40.40
|
| Rate for Payer: Prime Health Services Commercial |
$52.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.08
|
| Rate for Payer: United Healthcare All Other HMO |
$31.08
|
| Rate for Payer: United Healthcare HMO Rider |
$31.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$52.84
|
|
|
HC DRSNG MEPITEL 4 X 7.2" NON-ADH
|
Facility
|
OP
|
$65.60
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$55.76 |
| Rate for Payer: Adventist Health Commercial |
$13.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.28
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cigna of CA HMO |
$41.98
|
| Rate for Payer: Cigna of CA PPO |
$48.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.24
|
| Rate for Payer: EPIC Health Plan Senior |
$26.24
|
| Rate for Payer: Galaxy Health WC |
$55.76
|
| Rate for Payer: Global Benefits Group Commercial |
$39.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.92
|
| Rate for Payer: Multiplan Commercial |
$52.48
|
| Rate for Payer: Networks By Design Commercial |
$42.64
|
| Rate for Payer: Prime Health Services Commercial |
$55.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.80
|
| Rate for Payer: United Healthcare All Other HMO |
$32.80
|
| Rate for Payer: United Healthcare HMO Rider |
$32.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.76
|
| Rate for Payer: Vantage Medical Group Senior |
$55.76
|
|
|
HC DRSNG MEPITEL 4 X 7.2" NON-ADH
|
Facility
|
IP
|
$65.60
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$55.76 |
| Rate for Payer: Adventist Health Commercial |
$13.12
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.24
|
| Rate for Payer: EPIC Health Plan Senior |
$26.24
|
| Rate for Payer: Galaxy Health WC |
$55.76
|
| Rate for Payer: Global Benefits Group Commercial |
$39.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.74
|
| Rate for Payer: Multiplan Commercial |
$52.48
|
| Rate for Payer: Networks By Design Commercial |
$42.64
|
| Rate for Payer: Prime Health Services Commercial |
$55.76
|
|
|
HC DRSNG MEPITEL ONE 3X4IN
|
Facility
|
OP
|
$34.52
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901698763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$29.34 |
| Rate for Payer: Adventist Health Commercial |
$6.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.20
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Cigna of CA HMO |
$22.09
|
| Rate for Payer: Cigna of CA PPO |
$25.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.81
|
| Rate for Payer: Galaxy Health WC |
$29.34
|
| Rate for Payer: Global Benefits Group Commercial |
$20.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.16
|
| Rate for Payer: Multiplan Commercial |
$27.62
|
| Rate for Payer: Networks By Design Commercial |
$22.44
|
| Rate for Payer: Prime Health Services Commercial |
$29.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.26
|
| Rate for Payer: United Healthcare All Other HMO |
$17.26
|
| Rate for Payer: United Healthcare HMO Rider |
$17.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.34
|
| Rate for Payer: Vantage Medical Group Senior |
$29.34
|
|
|
HC DRSNG MEPITEL ONE 3X4IN
|
Facility
|
IP
|
$34.52
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901698763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$29.34 |
| Rate for Payer: Adventist Health Commercial |
$6.90
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.81
|
| Rate for Payer: Galaxy Health WC |
$29.34
|
| Rate for Payer: Global Benefits Group Commercial |
$20.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.28
|
| Rate for Payer: Multiplan Commercial |
$27.62
|
| Rate for Payer: Networks By Design Commercial |
$22.44
|
| Rate for Payer: Prime Health Services Commercial |
$29.34
|
|
|
HC DRSNG NON-ADHERENT 3 X 3
|
Facility
|
IP
|
$1.72
|
|
| Hospital Charge Code |
901600312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
|
|
HC DRSNG NON-ADHERENT 3 X 3
|
Facility
|
OP
|
$1.72
|
|
| Hospital Charge Code |
901600312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$1.10
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
HC DRSNG NON-ADHERENT 3 X 8
|
Facility
|
OP
|
$1.80
|
|
| Hospital Charge Code |
901600311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.11
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
HC DRSNG NON-ADHERENT 3 X 8
|
Facility
|
IP
|
$1.80
|
|
| Hospital Charge Code |
901600311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Senior |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.44
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
HC DRSNG NON-ADH PAD TELFA 3X4"
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901607908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
|
|
HC DRSNG NON-ADH PAD TELFA 3X4"
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901607908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.25
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Senior |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.29
|
| Rate for Payer: Multiplan Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
|
|
HC DRSNG NON-ADH PAD TELFA 3X8"
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901607909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
HC DRSNG NON-ADH PAD TELFA 3X8"
|
Facility
|
IP
|
$0.66
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901607909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
|
|
HC DRSNG, OPTIFOAM 4X4IN NON-ADH
|
Facility
|
IP
|
$21.89
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: EPIC Health Plan Senior |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.61
|
| Rate for Payer: Global Benefits Group Commercial |
$13.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$17.51
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
|
|
HC DRSNG, OPTIFOAM 4X4IN NON-ADH
|
Facility
|
OP
|
$21.89
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.44
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cigna of CA HMO |
$14.01
|
| Rate for Payer: Cigna of CA PPO |
$16.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.76
|
| Rate for Payer: EPIC Health Plan Senior |
$8.76
|
| Rate for Payer: Galaxy Health WC |
$18.61
|
| Rate for Payer: Global Benefits Group Commercial |
$13.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$17.51
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.61
|
| Rate for Payer: Vantage Medical Group Senior |
$18.61
|
|
|
HC DRSNG, OPTIFOAM 6X6IN NON-ADH
|
Facility
|
OP
|
$36.49
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901607528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.41
|
| Rate for Payer: Cash Price |
$20.07
|
| Rate for Payer: Cigna of CA HMO |
$23.35
|
| Rate for Payer: Cigna of CA PPO |
$27.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.54
|
| Rate for Payer: Multiplan Commercial |
$29.19
|
| Rate for Payer: Networks By Design Commercial |
$23.72
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.25
|
| Rate for Payer: United Healthcare All Other HMO |
$18.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
|
HC DRSNG, OPTIFOAM 6X6IN NON-ADH
|
Facility
|
IP
|
$36.49
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901607528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$31.02 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Cash Price |
$20.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.76
|
| Rate for Payer: Multiplan Commercial |
$29.19
|
| Rate for Payer: Networks By Design Commercial |
$23.72
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
|
|
HC DRSNG,OPTIFOAM AG 4X4" NON-ADH
|
Facility
|
OP
|
$43.54
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Adventist Health Commercial |
$8.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.74
|
| Rate for Payer: Cash Price |
$23.95
|
| Rate for Payer: Cigna of CA HMO |
$27.87
|
| Rate for Payer: Cigna of CA PPO |
$32.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Senior |
$17.42
|
| Rate for Payer: Galaxy Health WC |
$37.01
|
| Rate for Payer: Global Benefits Group Commercial |
$26.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.48
|
| Rate for Payer: Multiplan Commercial |
$34.83
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$37.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.77
|
| Rate for Payer: United Healthcare All Other HMO |
$21.77
|
| Rate for Payer: United Healthcare HMO Rider |
$21.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.01
|
| Rate for Payer: Vantage Medical Group Senior |
$37.01
|
|
|
HC DRSNG,OPTIFOAM AG 4X4" NON-ADH
|
Facility
|
IP
|
$43.54
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Adventist Health Commercial |
$8.71
|
| Rate for Payer: Cash Price |
$23.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Senior |
$17.42
|
| Rate for Payer: Galaxy Health WC |
$37.01
|
| Rate for Payer: Global Benefits Group Commercial |
$26.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Multiplan Commercial |
$34.83
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$37.01
|
|
|
HC DRSNG OPTIFOAM HRTMATE
|
Facility
|
OP
|
$10.09
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$8.58 |
| Rate for Payer: Adventist Health Commercial |
$2.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.20
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: Cigna of CA HMO |
$6.46
|
| Rate for Payer: Cigna of CA PPO |
$7.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$8.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.06
|
| Rate for Payer: Multiplan Commercial |
$8.07
|
| Rate for Payer: Networks By Design Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.58
|
| Rate for Payer: Vantage Medical Group Senior |
$8.58
|
|
|
HC DRSNG OPTIFOAM HRTMATE
|
Facility
|
IP
|
$10.09
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$8.58 |
| Rate for Payer: Adventist Health Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$5.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$8.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$8.07
|
| Rate for Payer: Networks By Design Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.58
|
|
|
HC DRSNG OPTIFOAM SACRUM 7X7"
|
Facility
|
IP
|
$52.15
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$44.33 |
| Rate for Payer: Adventist Health Commercial |
$10.43
|
| Rate for Payer: Cash Price |
$28.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.86
|
| Rate for Payer: EPIC Health Plan Senior |
$20.86
|
| Rate for Payer: Galaxy Health WC |
$44.33
|
| Rate for Payer: Global Benefits Group Commercial |
$31.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.52
|
| Rate for Payer: Multiplan Commercial |
$41.72
|
| Rate for Payer: Networks By Design Commercial |
$33.90
|
| Rate for Payer: Prime Health Services Commercial |
$44.33
|
|
