|
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 |
$27.90
|
| 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 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 |
$31.73
|
| 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 |
$31.73
|
| 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
|
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 |
$15.53
|
| 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 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 |
$15.53
|
| 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 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 |
$0.74
|
| 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 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 |
$0.74
|
| 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 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 |
$0.81
|
| 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 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 |
$0.81
|
| 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
|
|
|
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 |
$0.18
|
| 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 |
$0.18
|
| 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
|
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 |
$0.30
|
| 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 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 |
$0.30
|
| 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, 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 |
$9.85
|
| 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
|
|
|
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 |
$9.85
|
| 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 6X6IN NON-ADH
|
Facility
|
IP
|
$36.49
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901607528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Central Health Plan Commercial |
$29.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$27.37
|
| Rate for Payer: Networks By Design Commercial |
$23.72
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
|
|
HC DRSNG, OPTIFOAM 6X6IN NON-ADH
|
Facility
|
OP
|
$36.49
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901607528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.43
|
| Rate for Payer: Blue Shield of California Commercial |
$22.30
|
| Rate for Payer: Blue Shield of California EPN |
$14.56
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Central Health Plan Commercial |
$29.19
|
| Rate for Payer: Cigna of CA HMO |
$23.35
|
| Rate for Payer: Cigna of CA PPO |
$27.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.84
|
| Rate for Payer: InnovAge PACE Commercial |
$18.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.54
|
| Rate for Payer: Multiplan Commercial |
$27.37
|
| Rate for Payer: Networks By Design Commercial |
$23.72
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: Riverside University Health System MISP |
$14.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.25
|
| Rate for Payer: United Healthcare All Other HMO |
$18.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
|
HC DRSNG,OPTIFOAM AG 4X4" NON-ADH
|
Facility
|
IP
|
$43.54
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Adventist Health Commercial |
$8.71
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Central Health Plan Commercial |
$34.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Senior |
$17.42
|
| Rate for Payer: Galaxy Health WC |
$37.01
|
| Rate for Payer: Global Benefits Group Commercial |
$26.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.71
|
| Rate for Payer: Multiplan Commercial |
$32.66
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$37.01
|
|
|
HC DRSNG,OPTIFOAM AG 4X4" NON-ADH
|
Facility
|
OP
|
$43.54
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Adventist Health Commercial |
$8.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.57
|
| Rate for Payer: Blue Shield of California Commercial |
$26.60
|
| Rate for Payer: Blue Shield of California EPN |
$17.37
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Central Health Plan Commercial |
$34.83
|
| Rate for Payer: Cigna of CA HMO |
$27.87
|
| Rate for Payer: Cigna of CA PPO |
$32.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Senior |
$17.42
|
| Rate for Payer: Galaxy Health WC |
$37.01
|
| Rate for Payer: Global Benefits Group Commercial |
$26.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.19
|
| Rate for Payer: InnovAge PACE Commercial |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.48
|
| Rate for Payer: Multiplan Commercial |
$32.66
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$37.01
|
| Rate for Payer: Riverside University Health System MISP |
$17.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.77
|
| Rate for Payer: United Healthcare All Other HMO |
$21.77
|
| Rate for Payer: United Healthcare HMO Rider |
$21.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.01
|
| Rate for Payer: Vantage Medical Group Senior |
$37.01
|
|
|
HC DRSNG OPTIFOAM HRTMATE
|
Facility
|
IP
|
$10.09
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$9.08 |
| Rate for Payer: Adventist Health Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Central Health Plan Commercial |
$8.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$8.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$7.57
|
| Rate for Payer: Networks By Design Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.58
|
|
|
HC DRSNG OPTIFOAM HRTMATE
|
Facility
|
OP
|
$10.09
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$9.08 |
| Rate for Payer: Adventist Health Commercial |
$2.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6.16
|
| Rate for Payer: Blue Shield of California EPN |
$4.03
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Central Health Plan Commercial |
$8.07
|
| Rate for Payer: Cigna of CA HMO |
$6.46
|
| Rate for Payer: Cigna of CA PPO |
$7.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$8.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.08
|
| Rate for Payer: InnovAge PACE Commercial |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.06
|
| Rate for Payer: Multiplan Commercial |
$7.57
|
| Rate for Payer: Networks By Design Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.58
|
| Rate for Payer: Riverside University Health System MISP |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.58
|
| Rate for Payer: Vantage Medical Group Senior |
$8.58
|
|
|
HC DRSNG OPTIFOAM SACRUM 7X7"
|
Facility
|
IP
|
$52.07
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Central Health Plan Commercial |
$41.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$39.05
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
|
|
HC DRSNG OPTIFOAM SACRUM 7X7"
|
Facility
|
OP
|
$52.07
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.58
|
| Rate for Payer: Blue Shield of California Commercial |
$31.81
|
| Rate for Payer: Blue Shield of California EPN |
$20.78
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Central Health Plan Commercial |
$41.66
|
| Rate for Payer: Cigna of CA HMO |
$33.32
|
| Rate for Payer: Cigna of CA PPO |
$38.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.86
|
| Rate for Payer: InnovAge PACE Commercial |
$26.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$39.05
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
| Rate for Payer: Riverside University Health System MISP |
$20.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.04
|
| Rate for Payer: United Healthcare All Other HMO |
$26.04
|
| Rate for Payer: United Healthcare HMO Rider |
$26.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.26
|
| Rate for Payer: Vantage Medical Group Senior |
$44.26
|
|
|
HC DRSNG OPTIFOAM SACRUM 9X9"
|
Facility
|
OP
|
$81.75
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$73.58 |
| Rate for Payer: Adventist Health Commercial |
$16.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.01
|
| Rate for Payer: Blue Shield of California Commercial |
$49.95
|
| Rate for Payer: Blue Shield of California EPN |
$32.62
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Central Health Plan Commercial |
$65.40
|
| Rate for Payer: Cigna of CA HMO |
$52.32
|
| Rate for Payer: Cigna of CA PPO |
$60.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.70
|
| Rate for Payer: EPIC Health Plan Senior |
$32.70
|
| Rate for Payer: Galaxy Health WC |
$69.49
|
| Rate for Payer: Global Benefits Group Commercial |
$49.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.58
|
| Rate for Payer: InnovAge PACE Commercial |
$40.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.23
|
| Rate for Payer: Multiplan Commercial |
$61.31
|
| Rate for Payer: Networks By Design Commercial |
$53.14
|
| Rate for Payer: Prime Health Services Commercial |
$69.49
|
| Rate for Payer: Riverside University Health System MISP |
$32.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.88
|
| Rate for Payer: United Healthcare All Other HMO |
$40.88
|
| Rate for Payer: United Healthcare HMO Rider |
$40.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.49
|
| Rate for Payer: Vantage Medical Group Senior |
$69.49
|
|
|
HC DRSNG OPTIFOAM SACRUM 9X9"
|
Facility
|
IP
|
$81.75
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$73.58 |
| Rate for Payer: Adventist Health Commercial |
$16.35
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Central Health Plan Commercial |
$65.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.70
|
| Rate for Payer: EPIC Health Plan Senior |
$32.70
|
| Rate for Payer: Galaxy Health WC |
$69.49
|
| Rate for Payer: Global Benefits Group Commercial |
$49.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.35
|
| Rate for Payer: Multiplan Commercial |
$61.31
|
| Rate for Payer: Networks By Design Commercial |
$53.14
|
| Rate for Payer: Prime Health Services Commercial |
$69.49
|
|
