|
HC DRSNG MEPILEX POST-OP AG 4X8"
|
Facility
|
OP
|
$172.83
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$155.55 |
| Rate for Payer: Adventist Health Commercial |
$34.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.50
|
| Rate for Payer: Blue Shield of California Commercial |
$105.60
|
| Rate for Payer: Blue Shield of California EPN |
$68.96
|
| Rate for Payer: Cash Price |
$95.06
|
| Rate for Payer: Central Health Plan Commercial |
$138.26
|
| Rate for Payer: Cigna of CA HMO |
$110.61
|
| Rate for Payer: Cigna of CA PPO |
$127.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$146.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.13
|
| Rate for Payer: EPIC Health Plan Senior |
$69.13
|
| Rate for Payer: Galaxy Health WC |
$146.91
|
| Rate for Payer: Global Benefits Group Commercial |
$103.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.55
|
| Rate for Payer: InnovAge PACE Commercial |
$86.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120.98
|
| Rate for Payer: Multiplan Commercial |
$129.62
|
| Rate for Payer: Networks By Design Commercial |
$112.34
|
| Rate for Payer: Prime Health Services Commercial |
$146.91
|
| Rate for Payer: Riverside University Health System MISP |
$69.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.42
|
| Rate for Payer: United Healthcare All Other HMO |
$86.42
|
| Rate for Payer: United Healthcare HMO Rider |
$86.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$146.91
|
| Rate for Payer: Vantage Medical Group Senior |
$146.91
|
|
|
HC DRSNG MEPILEX SACRAL 7X7
|
Facility
|
OP
|
$47.48
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$9.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.89
|
| Rate for Payer: Blue Shield of California Commercial |
$29.01
|
| Rate for Payer: Blue Shield of California EPN |
$18.94
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Central Health Plan Commercial |
$37.98
|
| Rate for Payer: Cigna of CA HMO |
$30.39
|
| Rate for Payer: Cigna of CA PPO |
$35.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: EPIC Health Plan Senior |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.73
|
| Rate for Payer: InnovAge PACE Commercial |
$23.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.24
|
| Rate for Payer: Multiplan Commercial |
$35.61
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
| Rate for Payer: Riverside University Health System MISP |
$18.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.74
|
| Rate for Payer: United Healthcare All Other HMO |
$23.74
|
| Rate for Payer: United Healthcare HMO Rider |
$23.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.36
|
| Rate for Payer: Vantage Medical Group Senior |
$40.36
|
|
|
HC DRSNG MEPILEX SACRAL 7X7
|
Facility
|
IP
|
$47.48
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$9.50
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Central Health Plan Commercial |
$37.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: EPIC Health Plan Senior |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$35.61
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
|
|
HC DRSNG MEPILEX SACRAL 9X9
|
Facility
|
IP
|
$74.54
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$67.09 |
| Rate for Payer: Adventist Health Commercial |
$14.91
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Central Health Plan Commercial |
$59.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.82
|
| Rate for Payer: EPIC Health Plan Senior |
$29.82
|
| Rate for Payer: Galaxy Health WC |
$63.36
|
| Rate for Payer: Global Benefits Group Commercial |
$44.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.91
|
| Rate for Payer: Multiplan Commercial |
$55.91
|
| Rate for Payer: Networks By Design Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Commercial |
$63.36
|
|
|
HC DRSNG MEPILEX SACRAL 9X9
|
Facility
|
OP
|
$74.54
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$67.09 |
| Rate for Payer: Adventist Health Commercial |
$14.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.78
|
| Rate for Payer: Blue Shield of California Commercial |
$45.54
|
| Rate for Payer: Blue Shield of California EPN |
$29.74
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Central Health Plan Commercial |
$59.63
|
| Rate for Payer: Cigna of CA HMO |
$47.71
|
| Rate for Payer: Cigna of CA PPO |
$55.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.82
|
| Rate for Payer: EPIC Health Plan Senior |
$29.82
|
| Rate for Payer: Galaxy Health WC |
$63.36
|
| Rate for Payer: Global Benefits Group Commercial |
$44.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.09
|
| Rate for Payer: InnovAge PACE Commercial |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.18
|
| Rate for Payer: Multiplan Commercial |
$55.91
|
| Rate for Payer: Networks By Design Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Commercial |
$63.36
|
| Rate for Payer: Riverside University Health System MISP |
$29.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.27
|
| Rate for Payer: United Healthcare All Other HMO |
$37.27
|
| Rate for Payer: United Healthcare HMO Rider |
$37.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.36
|
| Rate for Payer: Vantage Medical Group Senior |
$63.36
|
|
|
HC DRSNG MEPILEX SACRUM 9.2X9.2
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901602024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRSNG MEPILEX SACRUM 9.2X9.2
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901602024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
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 |
$231.02 |
| Rate for Payer: Adventist Health Commercial |
$51.34
|
| Rate for Payer: Cash Price |
$141.18
|
| Rate for Payer: Central Health Plan Commercial |
$205.35
|
| 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: Health Management Network EPO/PPO |
$231.02
|
| 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 |
$51.34
|
| Rate for Payer: Multiplan Commercial |
$192.52
|
| Rate for Payer: Networks By Design Commercial |
$166.85
|
| Rate for Payer: Prime Health Services Commercial |
$218.19
|
|
|
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 |
$231.02 |
| Rate for Payer: Adventist Health Commercial |
$51.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.89
|
| 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 Exchange |
$124.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.75
|
| Rate for Payer: Blue Shield of California Commercial |
$156.84
|
| Rate for Payer: Blue Shield of California EPN |
$102.42
|
| Rate for Payer: Cash Price |
$141.18
|
| Rate for Payer: Central Health Plan Commercial |
$205.35
|
| 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: Health Management Network EPO/PPO |
$231.02
|
| Rate for Payer: InnovAge PACE Commercial |
$128.34
|
| 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 |
$51.34
|
| 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 |
$192.52
|
| Rate for Payer: Networks By Design Commercial |
$166.85
|
| Rate for Payer: Prime Health Services Commercial |
$218.19
|
| Rate for Payer: Riverside University Health System MISP |
$102.68
|
| 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 MEPITEL 1 NON-ADH 4X7"
|
Facility
|
IP
|
$61.99
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$55.79 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Cash Price |
$34.09
|
| Rate for Payer: Central Health Plan Commercial |
$49.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.69
|
| Rate for Payer: Global Benefits Group Commercial |
$37.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$46.49
|
| Rate for Payer: Networks By Design Commercial |
$40.29
|
| Rate for Payer: Prime Health Services Commercial |
$52.69
|
|
|
HC DRSNG MEPITEL 1 NON-ADH 4X7"
|
Facility
|
OP
|
$61.99
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$55.79 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.41
|
| Rate for Payer: Blue Shield of California Commercial |
$37.88
|
| Rate for Payer: Blue Shield of California EPN |
$24.73
|
| Rate for Payer: Cash Price |
$34.09
|
| Rate for Payer: Central Health Plan Commercial |
$49.59
|
| Rate for Payer: Cigna of CA HMO |
$39.67
|
| Rate for Payer: Cigna of CA PPO |
$45.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.69
|
| Rate for Payer: Global Benefits Group Commercial |
$37.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.79
|
| Rate for Payer: InnovAge PACE Commercial |
$31.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.39
|
| Rate for Payer: Multiplan Commercial |
$46.49
|
| Rate for Payer: Networks By Design Commercial |
$40.29
|
| Rate for Payer: Prime Health Services Commercial |
$52.69
|
| Rate for Payer: Riverside University Health System MISP |
$24.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.00
|
| Rate for Payer: United Healthcare All Other HMO |
$31.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.69
|
| Rate for Payer: Vantage Medical Group Senior |
$52.69
|
|
|
HC DRSNG MEPITEL 4 X 7.2" NON-ADH
|
Facility
|
IP
|
$70.52
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$63.47 |
| Rate for Payer: Adventist Health Commercial |
$14.10
|
| Rate for Payer: Cash Price |
$38.79
|
| Rate for Payer: Central Health Plan Commercial |
$56.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.21
|
| Rate for Payer: EPIC Health Plan Senior |
$28.21
|
| Rate for Payer: Galaxy Health WC |
$59.94
|
| Rate for Payer: Global Benefits Group Commercial |
$42.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.10
|
| Rate for Payer: Multiplan Commercial |
$52.89
|
| Rate for Payer: Networks By Design Commercial |
$45.84
|
| Rate for Payer: Prime Health Services Commercial |
$59.94
|
|
|
HC DRSNG MEPITEL 4 X 7.2" NON-ADH
|
Facility
|
OP
|
$70.52
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$63.47 |
| Rate for Payer: Adventist Health Commercial |
$14.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.42
|
| Rate for Payer: Blue Shield of California Commercial |
$43.09
|
| Rate for Payer: Blue Shield of California EPN |
$28.14
|
| Rate for Payer: Cash Price |
$38.79
|
| Rate for Payer: Central Health Plan Commercial |
$56.42
|
| Rate for Payer: Cigna of CA HMO |
$45.13
|
| Rate for Payer: Cigna of CA PPO |
$52.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.21
|
| Rate for Payer: EPIC Health Plan Senior |
$28.21
|
| Rate for Payer: Galaxy Health WC |
$59.94
|
| Rate for Payer: Global Benefits Group Commercial |
$42.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.47
|
| Rate for Payer: InnovAge PACE Commercial |
$35.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.36
|
| Rate for Payer: Multiplan Commercial |
$52.89
|
| Rate for Payer: Networks By Design Commercial |
$45.84
|
| Rate for Payer: Prime Health Services Commercial |
$59.94
|
| Rate for Payer: Riverside University Health System MISP |
$28.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.26
|
| Rate for Payer: United Healthcare All Other HMO |
$35.26
|
| Rate for Payer: United Healthcare HMO Rider |
$35.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.94
|
| Rate for Payer: Vantage Medical Group Senior |
$59.94
|
|
|
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 |
$31.07 |
| Rate for Payer: Adventist Health Commercial |
$6.90
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Central Health Plan Commercial |
$27.62
|
| 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: Health Management Network EPO/PPO |
$31.07
|
| 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 |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$25.89
|
| Rate for Payer: Networks By Design Commercial |
$22.44
|
| Rate for Payer: Prime Health Services Commercial |
$29.34
|
|
|
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 |
$31.07 |
| Rate for Payer: Adventist Health Commercial |
$6.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.96
|
| 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 Exchange |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.27
|
| Rate for Payer: Blue Shield of California Commercial |
$21.09
|
| Rate for Payer: Blue Shield of California EPN |
$13.77
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Central Health Plan Commercial |
$27.62
|
| 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: Health Management Network EPO/PPO |
$31.07
|
| Rate for Payer: InnovAge PACE Commercial |
$17.26
|
| 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 |
$6.90
|
| 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 |
$25.89
|
| Rate for Payer: Networks By Design Commercial |
$22.44
|
| Rate for Payer: Prime Health Services Commercial |
$29.34
|
| Rate for Payer: Riverside University Health System MISP |
$13.81
|
| 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 NON-ADHERENT 3 X 3
|
Facility
|
IP
|
$1.64
|
|
| Hospital Charge Code |
901600312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.23
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
|
|
HC DRSNG NON-ADHERENT 3 X 3
|
Facility
|
OP
|
$1.64
|
|
| Hospital Charge Code |
901600312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.48
|
| Rate for Payer: InnovAge PACE Commercial |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.23
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
|
|
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 |
$1.62 |
| Rate for Payer: Adventist Health Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.99
|
| 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
|
|
|
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 |
$1.62 |
| 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 |
$0.99
|
| 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 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 |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| 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 Exchange |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| 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: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: InnovAge PACE Commercial |
$0.21
|
| 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 |
$0.08
|
| 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 |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Riverside University Health System MISP |
$0.16
|
| 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 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 |
$0.37 |
| Rate for Payer: Adventist Health Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| 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: Health Management Network EPO/PPO |
$0.37
|
| 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 |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
|
|
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 |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| 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: Health Management Network EPO/PPO |
$0.59
|
| 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 |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
|
|
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 |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.40
|
| 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 Exchange |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| 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: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: InnovAge PACE Commercial |
$0.33
|
| 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 |
$0.13
|
| 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 |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Riverside University Health System MISP |
$0.26
|
| 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, 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 |
$19.70 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.29
|
| 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 Exchange |
$10.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.86
|
| Rate for Payer: Blue Shield of California Commercial |
$13.37
|
| Rate for Payer: Blue Shield of California EPN |
$8.73
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Central Health Plan Commercial |
$17.51
|
| 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: Health Management Network EPO/PPO |
$19.70
|
| Rate for Payer: InnovAge PACE Commercial |
$10.95
|
| 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 |
$4.38
|
| 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 |
$16.42
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
| Rate for Payer: Riverside University Health System MISP |
$8.76
|
| 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 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 |
$19.70 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Central Health Plan Commercial |
$17.51
|
| 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: Health Management Network EPO/PPO |
$19.70
|
| 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 |
$4.38
|
| Rate for Payer: Multiplan Commercial |
$16.42
|
| Rate for Payer: Networks By Design Commercial |
$14.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.61
|
|
