|
HC DRSNG DUODERM CGF 2X8" X-THIN
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| 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: Health Management Network EPO/PPO |
$14.90
|
| 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 |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
HC DRSNG DUODERM CGF 4X4IN
|
Facility
|
OP
|
$18.20
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698658
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.12
|
| Rate for Payer: Blue Shield of California EPN |
$7.26
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Central Health Plan Commercial |
$14.56
|
| Rate for Payer: Cigna of CA HMO |
$11.65
|
| Rate for Payer: Cigna of CA PPO |
$13.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.38
|
| Rate for Payer: InnovAge PACE Commercial |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.74
|
| Rate for Payer: Multiplan Commercial |
$13.65
|
| Rate for Payer: Networks By Design Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$15.47
|
| Rate for Payer: Riverside University Health System MISP |
$7.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other HMO |
$9.10
|
| Rate for Payer: United Healthcare HMO Rider |
$9.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.47
|
| Rate for Payer: Vantage Medical Group Senior |
$15.47
|
|
|
HC DRSNG DUODERM CGF 4X4IN
|
Facility
|
IP
|
$18.20
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698658
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Central Health Plan Commercial |
$14.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$13.65
|
| Rate for Payer: Networks By Design Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$15.47
|
|
|
HC DRSNG DUODERM CGF 6X6IN
|
Facility
|
IP
|
$130.87
|
|
|
Service Code
|
CPT A6235
|
| Hospital Charge Code |
901698660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$117.78 |
| Rate for Payer: Adventist Health Commercial |
$26.17
|
| Rate for Payer: Cash Price |
$58.89
|
| Rate for Payer: Central Health Plan Commercial |
$104.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.35
|
| Rate for Payer: EPIC Health Plan Senior |
$52.35
|
| Rate for Payer: Galaxy Health WC |
$111.24
|
| Rate for Payer: Global Benefits Group Commercial |
$78.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.17
|
| Rate for Payer: Multiplan Commercial |
$98.15
|
| Rate for Payer: Networks By Design Commercial |
$85.07
|
| Rate for Payer: Prime Health Services Commercial |
$111.24
|
|
|
HC DRSNG DUODERM CGF 6X6IN
|
Facility
|
OP
|
$130.87
|
|
|
Service Code
|
CPT A6235
|
| Hospital Charge Code |
901698660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$117.78 |
| Rate for Payer: Adventist Health Commercial |
$26.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.86
|
| Rate for Payer: Blue Shield of California Commercial |
$79.96
|
| Rate for Payer: Blue Shield of California EPN |
$52.22
|
| Rate for Payer: Cash Price |
$58.89
|
| Rate for Payer: Central Health Plan Commercial |
$104.70
|
| Rate for Payer: Cigna of CA HMO |
$83.76
|
| Rate for Payer: Cigna of CA PPO |
$96.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.35
|
| Rate for Payer: EPIC Health Plan Senior |
$52.35
|
| Rate for Payer: Galaxy Health WC |
$111.24
|
| Rate for Payer: Global Benefits Group Commercial |
$78.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.78
|
| Rate for Payer: InnovAge PACE Commercial |
$65.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.61
|
| Rate for Payer: Multiplan Commercial |
$98.15
|
| Rate for Payer: Networks By Design Commercial |
$85.07
|
| Rate for Payer: Prime Health Services Commercial |
$111.24
|
| Rate for Payer: Riverside University Health System MISP |
$52.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.44
|
| Rate for Payer: United Healthcare All Other HMO |
$65.44
|
| Rate for Payer: United Healthcare HMO Rider |
$65.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.24
|
| Rate for Payer: Vantage Medical Group Senior |
$111.24
|
|
|
HC DRSNG DUODERM CGF 8X8IN
|
Facility
|
IP
|
$57.32
|
|
|
Service Code
|
CPT A6236
|
| Hospital Charge Code |
901698657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$51.59 |
| Rate for Payer: Adventist Health Commercial |
$11.46
|
| Rate for Payer: Cash Price |
$25.79
|
| Rate for Payer: Central Health Plan Commercial |
$45.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.93
|
| Rate for Payer: EPIC Health Plan Senior |
$22.93
|
| Rate for Payer: Galaxy Health WC |
$48.72
|
| Rate for Payer: Global Benefits Group Commercial |
$34.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.46
|
| Rate for Payer: Multiplan Commercial |
$42.99
|
| Rate for Payer: Networks By Design Commercial |
$37.26
|
| Rate for Payer: Prime Health Services Commercial |
$48.72
|
|
|
HC DRSNG DUODERM CGF 8X8IN
|
Facility
|
OP
|
$57.32
|
|
|
Service Code
|
CPT A6236
|
| Hospital Charge Code |
901698657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$51.59 |
| Rate for Payer: Adventist Health Commercial |
$11.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.66
|
| Rate for Payer: Blue Shield of California Commercial |
$35.02
|
| Rate for Payer: Blue Shield of California EPN |
$22.87
|
| Rate for Payer: Cash Price |
$25.79
|
| Rate for Payer: Central Health Plan Commercial |
$45.86
|
| Rate for Payer: Cigna of CA HMO |
$36.68
|
| Rate for Payer: Cigna of CA PPO |
$42.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.93
|
| Rate for Payer: EPIC Health Plan Senior |
$22.93
|
| Rate for Payer: Galaxy Health WC |
$48.72
|
| Rate for Payer: Global Benefits Group Commercial |
$34.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.59
|
| Rate for Payer: InnovAge PACE Commercial |
$28.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.12
|
| Rate for Payer: Multiplan Commercial |
$42.99
|
| Rate for Payer: Networks By Design Commercial |
$37.26
|
| Rate for Payer: Prime Health Services Commercial |
$48.72
|
| Rate for Payer: Riverside University Health System MISP |
$22.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.66
|
| Rate for Payer: United Healthcare All Other HMO |
$28.66
|
| Rate for Payer: United Healthcare HMO Rider |
$28.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.72
|
| Rate for Payer: Vantage Medical Group Senior |
$48.72
|
|
|
HC DRSNG EXUDERM THIN HCD 4X4
|
Facility
|
OP
|
$14.27
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901607526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$12.84 |
| Rate for Payer: Adventist Health Commercial |
$2.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.38
|
| Rate for Payer: Blue Shield of California Commercial |
$8.72
|
| Rate for Payer: Blue Shield of California EPN |
$5.69
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: Central Health Plan Commercial |
$11.42
|
| Rate for Payer: Cigna of CA HMO |
$9.13
|
| Rate for Payer: Cigna of CA PPO |
$10.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.71
|
| Rate for Payer: EPIC Health Plan Senior |
$5.71
|
| Rate for Payer: Galaxy Health WC |
$12.13
|
| Rate for Payer: Global Benefits Group Commercial |
$8.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.84
|
| Rate for Payer: InnovAge PACE Commercial |
$7.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.99
|
| Rate for Payer: Multiplan Commercial |
$10.70
|
| Rate for Payer: Networks By Design Commercial |
$9.28
|
| Rate for Payer: Prime Health Services Commercial |
$12.13
|
| Rate for Payer: Riverside University Health System MISP |
$5.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.13
|
| Rate for Payer: United Healthcare All Other HMO |
$7.13
|
| Rate for Payer: United Healthcare HMO Rider |
$7.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Vantage Medical Group Senior |
$12.13
|
|
|
HC DRSNG EXUDERM THIN HCD 4X4
|
Facility
|
IP
|
$14.27
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901607526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$12.84 |
| Rate for Payer: Adventist Health Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: Central Health Plan Commercial |
$11.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.71
|
| Rate for Payer: EPIC Health Plan Senior |
$5.71
|
| Rate for Payer: Galaxy Health WC |
$12.13
|
| Rate for Payer: Global Benefits Group Commercial |
$8.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.85
|
| Rate for Payer: Multiplan Commercial |
$10.70
|
| Rate for Payer: Networks By Design Commercial |
$9.28
|
| Rate for Payer: Prime Health Services Commercial |
$12.13
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 4X4
|
Facility
|
OP
|
$53.38
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$48.04 |
| Rate for Payer: Adventist Health Commercial |
$10.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.35
|
| Rate for Payer: Blue Shield of California Commercial |
$32.62
|
| Rate for Payer: Blue Shield of California EPN |
$21.30
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Central Health Plan Commercial |
$42.70
|
| Rate for Payer: Cigna of CA HMO |
$34.16
|
| Rate for Payer: Cigna of CA PPO |
$39.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.35
|
| Rate for Payer: EPIC Health Plan Senior |
$21.35
|
| Rate for Payer: Galaxy Health WC |
$45.37
|
| Rate for Payer: Global Benefits Group Commercial |
$32.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.04
|
| Rate for Payer: InnovAge PACE Commercial |
$26.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.37
|
| Rate for Payer: Multiplan Commercial |
$40.03
|
| Rate for Payer: Networks By Design Commercial |
$34.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.37
|
| Rate for Payer: Riverside University Health System MISP |
$21.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.69
|
| Rate for Payer: United Healthcare All Other HMO |
$26.69
|
| Rate for Payer: United Healthcare HMO Rider |
$26.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.37
|
| Rate for Payer: Vantage Medical Group Senior |
$45.37
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 4X4
|
Facility
|
IP
|
$53.38
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$48.04 |
| Rate for Payer: Adventist Health Commercial |
$10.68
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Central Health Plan Commercial |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.35
|
| Rate for Payer: EPIC Health Plan Senior |
$21.35
|
| Rate for Payer: Galaxy Health WC |
$45.37
|
| Rate for Payer: Global Benefits Group Commercial |
$32.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$40.03
|
| Rate for Payer: Networks By Design Commercial |
$34.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.37
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 6X6
|
Facility
|
IP
|
$734.80
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.96 |
| Max. Negotiated Rate |
$661.32 |
| Rate for Payer: Adventist Health Commercial |
$146.96
|
| Rate for Payer: Cash Price |
$330.66
|
| Rate for Payer: Central Health Plan Commercial |
$587.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.92
|
| Rate for Payer: EPIC Health Plan Senior |
$293.92
|
| Rate for Payer: Galaxy Health WC |
$624.58
|
| Rate for Payer: Global Benefits Group Commercial |
$440.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$661.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$490.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$454.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.96
|
| Rate for Payer: Multiplan Commercial |
$551.10
|
| Rate for Payer: Networks By Design Commercial |
$477.62
|
| Rate for Payer: Prime Health Services Commercial |
$624.58
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 6X6
|
Facility
|
OP
|
$109.59
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$98.63 |
| Rate for Payer: Adventist Health Commercial |
$21.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.36
|
| Rate for Payer: Blue Shield of California Commercial |
$66.96
|
| Rate for Payer: Blue Shield of California EPN |
$43.73
|
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Central Health Plan Commercial |
$87.67
|
| Rate for Payer: Cigna of CA HMO |
$70.14
|
| Rate for Payer: Cigna of CA PPO |
$81.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.84
|
| Rate for Payer: EPIC Health Plan Senior |
$43.84
|
| Rate for Payer: Galaxy Health WC |
$93.15
|
| Rate for Payer: Global Benefits Group Commercial |
$65.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.63
|
| Rate for Payer: InnovAge PACE Commercial |
$54.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.71
|
| Rate for Payer: Multiplan Commercial |
$82.19
|
| Rate for Payer: Networks By Design Commercial |
$71.23
|
| Rate for Payer: Prime Health Services Commercial |
$93.15
|
| Rate for Payer: Riverside University Health System MISP |
$43.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.80
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$54.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.15
|
| Rate for Payer: Vantage Medical Group Senior |
$93.15
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 6X6
|
Facility
|
IP
|
$109.59
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$98.63 |
| Rate for Payer: Adventist Health Commercial |
$21.92
|
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Central Health Plan Commercial |
$87.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.84
|
| Rate for Payer: EPIC Health Plan Senior |
$43.84
|
| Rate for Payer: Galaxy Health WC |
$93.15
|
| Rate for Payer: Global Benefits Group Commercial |
$65.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.92
|
| Rate for Payer: Multiplan Commercial |
$82.19
|
| Rate for Payer: Networks By Design Commercial |
$71.23
|
| Rate for Payer: Prime Health Services Commercial |
$93.15
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 6X6
|
Facility
|
OP
|
$734.80
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.96 |
| Max. Negotiated Rate |
$661.32 |
| Rate for Payer: Adventist Health Commercial |
$146.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$446.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$624.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$404.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$551.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$355.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.55
|
| Rate for Payer: Blue Shield of California Commercial |
$448.96
|
| Rate for Payer: Blue Shield of California EPN |
$293.19
|
| Rate for Payer: Cash Price |
$330.66
|
| Rate for Payer: Central Health Plan Commercial |
$587.84
|
| Rate for Payer: Cigna of CA HMO |
$470.27
|
| Rate for Payer: Cigna of CA PPO |
$543.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$624.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$624.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$624.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.92
|
| Rate for Payer: EPIC Health Plan Senior |
$293.92
|
| Rate for Payer: Galaxy Health WC |
$624.58
|
| Rate for Payer: Global Benefits Group Commercial |
$440.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$661.32
|
| Rate for Payer: InnovAge PACE Commercial |
$367.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$490.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$454.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$514.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$514.36
|
| Rate for Payer: Multiplan Commercial |
$551.10
|
| Rate for Payer: Networks By Design Commercial |
$477.62
|
| Rate for Payer: Prime Health Services Commercial |
$624.58
|
| Rate for Payer: Riverside University Health System MISP |
$293.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$440.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$440.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$367.40
|
| Rate for Payer: United Healthcare All Other HMO |
$367.40
|
| Rate for Payer: United Healthcare HMO Rider |
$367.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$624.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$624.58
|
| Rate for Payer: Vantage Medical Group Senior |
$624.58
|
|
|
HC DRSNG FOAM MEPILEX 3X3" FLEX
|
Facility
|
OP
|
$15.58
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$14.02 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.15
|
| Rate for Payer: Blue Shield of California Commercial |
$9.52
|
| Rate for Payer: Blue Shield of California EPN |
$6.22
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Central Health Plan Commercial |
$12.46
|
| Rate for Payer: Cigna of CA HMO |
$9.97
|
| Rate for Payer: Cigna of CA PPO |
$11.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Senior |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.02
|
| Rate for Payer: InnovAge PACE Commercial |
$7.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
| Rate for Payer: Riverside University Health System MISP |
$6.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.79
|
| Rate for Payer: United Healthcare All Other HMO |
$7.79
|
| Rate for Payer: United Healthcare HMO Rider |
$7.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.24
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC DRSNG FOAM MEPILEX 3X3" FLEX
|
Facility
|
IP
|
$15.58
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$14.02 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Central Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Senior |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$11.69
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
|
|
HC DRSNG FOAM MEPILEX 4X4" FLEX
|
Facility
|
OP
|
$21.16
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.43
|
| Rate for Payer: Blue Shield of California Commercial |
$12.93
|
| Rate for Payer: Blue Shield of California EPN |
$8.44
|
| Rate for Payer: Cash Price |
$9.52
|
| Rate for Payer: Central Health Plan Commercial |
$16.93
|
| Rate for Payer: Cigna of CA HMO |
$13.54
|
| Rate for Payer: Cigna of CA PPO |
$15.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: InnovAge PACE Commercial |
$10.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.81
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
| Rate for Payer: Riverside University Health System MISP |
$8.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.99
|
| Rate for Payer: Vantage Medical Group Senior |
$17.99
|
|
|
HC DRSNG FOAM MEPILEX 4X4" FLEX
|
Facility
|
IP
|
$21.16
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$9.52
|
| Rate for Payer: Central Health Plan Commercial |
$16.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
|
|
HC DRSNG FOAM MEPILEX 6X6" FLEX
|
Facility
|
OP
|
$35.92
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$32.33 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.81
|
| 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 Exchange |
$17.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.10
|
| Rate for Payer: Blue Shield of California Commercial |
$21.95
|
| Rate for Payer: Blue Shield of California EPN |
$14.33
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Central Health Plan Commercial |
$28.74
|
| 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: Health Management Network EPO/PPO |
$32.33
|
| Rate for Payer: InnovAge PACE Commercial |
$17.96
|
| 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 |
$7.18
|
| 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 |
$26.94
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
| Rate for Payer: Riverside University Health System MISP |
$14.37
|
| 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 FOAM MEPILEX 6X6" FLEX
|
Facility
|
IP
|
$35.92
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$32.33 |
| Rate for Payer: Adventist Health Commercial |
$7.18
|
| Rate for Payer: Cash Price |
$16.16
|
| Rate for Payer: Central Health Plan Commercial |
$28.74
|
| 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: Health Management Network EPO/PPO |
$32.33
|
| 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 |
$7.18
|
| Rate for Payer: Multiplan Commercial |
$26.94
|
| Rate for Payer: Networks By Design Commercial |
$23.35
|
| Rate for Payer: Prime Health Services Commercial |
$30.53
|
|
|
HC DRSNG FOAM MEPILEX 6X8" FLEX
|
Facility
|
IP
|
$44.28
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Adventist Health Commercial |
$8.86
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Central Health Plan Commercial |
$35.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.71
|
| Rate for Payer: EPIC Health Plan Senior |
$17.71
|
| Rate for Payer: Galaxy Health WC |
$37.64
|
| Rate for Payer: Global Benefits Group Commercial |
$26.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$33.21
|
| Rate for Payer: Networks By Design Commercial |
$28.78
|
| Rate for Payer: Prime Health Services Commercial |
$37.64
|
|
|
HC DRSNG FOAM MEPILEX 6X8" FLEX
|
Facility
|
OP
|
$44.28
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Adventist Health Commercial |
$8.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.01
|
| Rate for Payer: Blue Shield of California Commercial |
$27.06
|
| Rate for Payer: Blue Shield of California EPN |
$17.67
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Central Health Plan Commercial |
$35.42
|
| Rate for Payer: Cigna of CA HMO |
$28.34
|
| Rate for Payer: Cigna of CA PPO |
$32.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.71
|
| Rate for Payer: EPIC Health Plan Senior |
$17.71
|
| Rate for Payer: Galaxy Health WC |
$37.64
|
| Rate for Payer: Global Benefits Group Commercial |
$26.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.85
|
| Rate for Payer: InnovAge PACE Commercial |
$22.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.00
|
| Rate for Payer: Multiplan Commercial |
$33.21
|
| Rate for Payer: Networks By Design Commercial |
$28.78
|
| Rate for Payer: Prime Health Services Commercial |
$37.64
|
| Rate for Payer: Riverside University Health System MISP |
$17.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$22.14
|
| Rate for Payer: United Healthcare HMO Rider |
$22.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.64
|
| Rate for Payer: Vantage Medical Group Senior |
$37.64
|
|
|
HC DRSNG GAUZE NON-ADHERENT 3X3"
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
| 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 Exchange |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1.10
|
| Rate for Payer: Blue Shield of California EPN |
$0.72
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| 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: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: InnovAge PACE Commercial |
$0.90
|
| 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 |
$0.36
|
| 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 |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Riverside University Health System MISP |
$0.72
|
| 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 GAUZE NON-ADHERENT 3X3"
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| 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: Health Management Network EPO/PPO |
$1.62
|
| 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 |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
