|
HC DRSNG EXUDERM THIN HCD 4X4
|
Facility
|
IP
|
$15.25
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901607526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$13.72 |
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Central Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: Galaxy Health WC |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$9.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$11.44
|
| Rate for Payer: Networks By Design Commercial |
$9.91
|
| Rate for Payer: Prime Health Services Commercial |
$12.96
|
|
|
HC DRSNG EXUDERM THIN HCD 4X4
|
Facility
|
OP
|
$15.25
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901607526
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$13.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.01
|
| Rate for Payer: Blue Distinction Transplant |
$9.15
|
| Rate for Payer: Blue Shield of California Commercial |
$9.59
|
| Rate for Payer: Blue Shield of California EPN |
$7.46
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Central Health Plan Commercial |
$12.20
|
| Rate for Payer: Cigna of CA HMO |
$9.76
|
| Rate for Payer: Cigna of CA PPO |
$11.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.96
|
| Rate for Payer: Dignity Health Media |
$12.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.10
|
| Rate for Payer: Galaxy Health WC |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$9.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$11.44
|
| Rate for Payer: Networks By Design Commercial |
$9.91
|
| Rate for Payer: Prime Health Services Commercial |
$12.96
|
| Rate for Payer: Riverside University Health System MISP |
$6.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.62
|
| Rate for Payer: United Healthcare All Other HMO |
$7.62
|
| Rate for Payer: United Healthcare HMO Rider |
$7.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.96
|
| Rate for Payer: Vantage Medical Group Senior |
$12.96
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 4X4
|
Facility
|
OP
|
$53.38
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$48.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.54
|
| Rate for Payer: Blue Distinction Transplant |
$32.03
|
| Rate for Payer: Blue Shield of California Commercial |
$33.58
|
| Rate for Payer: Blue Shield of California EPN |
$26.10
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Central Health Plan Commercial |
$42.70
|
| Rate for Payer: Cigna of CA HMO |
$34.16
|
| Rate for Payer: Cigna of CA PPO |
$39.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.37
|
| Rate for Payer: Dignity Health Media |
$45.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.35
|
| Rate for Payer: Galaxy Health WC |
$45.37
|
| Rate for Payer: Global Benefits Group Commercial |
$32.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$40.04
|
| Rate for Payer: Networks By Design Commercial |
$34.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.37
|
| Rate for Payer: Riverside University Health System MISP |
$21.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.69
|
| Rate for Payer: United Healthcare All Other HMO |
$26.69
|
| Rate for Payer: United Healthcare HMO Rider |
$26.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.37
|
| Rate for Payer: Vantage Medical Group Senior |
$45.37
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 4X4
|
Facility
|
IP
|
$53.38
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$48.04 |
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Central Health Plan Commercial |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.35
|
| Rate for Payer: Galaxy Health WC |
$45.37
|
| Rate for Payer: Global Benefits Group Commercial |
$32.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$40.04
|
| Rate for Payer: Networks By Design Commercial |
$34.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.37
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 6X6
|
Facility
|
IP
|
$109.59
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$98.63 |
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Central Health Plan Commercial |
$87.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.84
|
| Rate for Payer: Galaxy Health WC |
$93.15
|
| Rate for Payer: Global Benefits Group Commercial |
$65.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.92
|
| Rate for Payer: Multiplan Commercial |
$82.19
|
| Rate for Payer: Networks By Design Commercial |
$71.23
|
| Rate for Payer: Prime Health Services Commercial |
$93.15
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 6X6
|
Facility
|
IP
|
$109.59
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$98.63 |
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Central Health Plan Commercial |
$87.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.84
|
| Rate for Payer: Galaxy Health WC |
$93.15
|
| Rate for Payer: Global Benefits Group Commercial |
$65.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.92
|
| Rate for Payer: Multiplan Commercial |
$82.19
|
| Rate for Payer: Networks By Design Commercial |
$71.23
|
| Rate for Payer: Prime Health Services Commercial |
$93.15
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 6X6
|
Facility
|
OP
|
$109.59
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$98.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.75
|
| Rate for Payer: Blue Distinction Transplant |
$65.75
|
| Rate for Payer: Blue Shield of California Commercial |
$68.93
|
| Rate for Payer: Blue Shield of California EPN |
$53.59
|
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Central Health Plan Commercial |
$87.67
|
| Rate for Payer: Cigna of CA HMO |
$70.14
|
| Rate for Payer: Cigna of CA PPO |
$81.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.15
|
| Rate for Payer: Dignity Health Media |
$93.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.84
|
| Rate for Payer: Galaxy Health WC |
$93.15
|
| Rate for Payer: Global Benefits Group Commercial |
$65.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.63
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$82.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.92
|
| Rate for Payer: Multiplan Commercial |
$82.19
|
| Rate for Payer: Networks By Design Commercial |
$71.23
|
| Rate for Payer: Prime Health Services Commercial |
$93.15
|
| Rate for Payer: Riverside University Health System MISP |
$43.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.80
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$54.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.15
|
| Rate for Payer: Vantage Medical Group Senior |
$93.15
|
|
|
HC DRSNG FOAM HYDROFERA BLUE 6X6
|
Facility
|
OP
|
$109.59
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$98.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.75
|
| Rate for Payer: Blue Distinction Transplant |
$65.75
|
| Rate for Payer: Blue Shield of California Commercial |
$68.93
|
| Rate for Payer: Blue Shield of California EPN |
$53.59
|
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Central Health Plan Commercial |
$87.67
|
| Rate for Payer: Cigna of CA HMO |
$70.14
|
| Rate for Payer: Cigna of CA PPO |
$81.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.15
|
| Rate for Payer: Dignity Health Media |
$93.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.84
|
| Rate for Payer: Galaxy Health WC |
$93.15
|
| Rate for Payer: Global Benefits Group Commercial |
$65.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.63
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$82.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.92
|
| Rate for Payer: Multiplan Commercial |
$82.19
|
| Rate for Payer: Networks By Design Commercial |
$71.23
|
| Rate for Payer: Prime Health Services Commercial |
$93.15
|
| Rate for Payer: Riverside University Health System MISP |
$43.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.80
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$54.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.15
|
| Rate for Payer: Vantage Medical Group Senior |
$93.15
|
|
|
HC DRSNG FOAM MEPILEX 3X3" FLEX
|
Facility
|
IP
|
$15.58
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$14.02 |
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Central Health Plan Commercial |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$11.68
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
|
|
HC DRSNG FOAM MEPILEX 3X3" FLEX
|
Facility
|
OP
|
$15.58
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.20
|
| Rate for Payer: Blue Distinction Transplant |
$9.35
|
| Rate for Payer: Blue Shield of California Commercial |
$9.80
|
| Rate for Payer: Blue Shield of California EPN |
$7.62
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Central Health Plan Commercial |
$12.46
|
| Rate for Payer: Cigna of CA HMO |
$9.97
|
| Rate for Payer: Cigna of CA PPO |
$11.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.24
|
| Rate for Payer: Dignity Health Media |
$13.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.23
|
| Rate for Payer: Galaxy Health WC |
$13.24
|
| Rate for Payer: Global Benefits Group Commercial |
$9.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$11.68
|
| Rate for Payer: Networks By Design Commercial |
$10.13
|
| Rate for Payer: Prime Health Services Commercial |
$13.24
|
| Rate for Payer: Riverside University Health System MISP |
$6.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.79
|
| Rate for Payer: United Healthcare All Other HMO |
$7.79
|
| Rate for Payer: United Healthcare HMO Rider |
$7.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.24
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC DRSNG FOAM MEPILEX 4X4" FLEX
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Central Health Plan Commercial |
$16.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$15.93
|
| Rate for Payer: Networks By Design Commercial |
$13.81
|
| Rate for Payer: Prime Health Services Commercial |
$18.05
|
|
|
HC DRSNG FOAM MEPILEX 4X4" FLEX
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.55
|
| Rate for Payer: Blue Distinction Transplant |
$12.74
|
| Rate for Payer: Blue Shield of California Commercial |
$13.36
|
| Rate for Payer: Blue Shield of California EPN |
$10.39
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Central Health Plan Commercial |
$16.99
|
| Rate for Payer: Cigna of CA HMO |
$13.59
|
| Rate for Payer: Cigna of CA PPO |
$15.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.05
|
| Rate for Payer: Dignity Health Media |
$18.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.12
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$15.93
|
| Rate for Payer: Networks By Design Commercial |
$13.81
|
| Rate for Payer: Prime Health Services Commercial |
$18.05
|
| Rate for Payer: Riverside University Health System MISP |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.62
|
| Rate for Payer: United Healthcare All Other HMO |
$10.62
|
| Rate for Payer: United Healthcare HMO Rider |
$10.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.05
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
|
|
HC DRSNG FOAM MEPILEX 6X6" FLEX
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC DRSNG FOAM MEPILEX 6X6" FLEX
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.27
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.64
|
| Rate for Payer: Blue Shield of California EPN |
$17.60
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Media |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC DRSNG FOAM MEPILEX 6X8" FLEX
|
Facility
|
OP
|
$44.36
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.21
|
| Rate for Payer: Blue Distinction Transplant |
$26.62
|
| Rate for Payer: Blue Shield of California Commercial |
$27.90
|
| Rate for Payer: Blue Shield of California EPN |
$21.69
|
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Central Health Plan Commercial |
$35.49
|
| Rate for Payer: Cigna of CA HMO |
$28.39
|
| Rate for Payer: Cigna of CA PPO |
$32.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.71
|
| Rate for Payer: Dignity Health Media |
$37.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.74
|
| Rate for Payer: Galaxy Health WC |
$37.71
|
| Rate for Payer: Global Benefits Group Commercial |
$26.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.87
|
| Rate for Payer: Multiplan Commercial |
$33.27
|
| Rate for Payer: Networks By Design Commercial |
$28.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.71
|
| Rate for Payer: Riverside University Health System MISP |
$17.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.18
|
| Rate for Payer: United Healthcare All Other HMO |
$22.18
|
| Rate for Payer: United Healthcare HMO Rider |
$22.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.71
|
| Rate for Payer: Vantage Medical Group Senior |
$37.71
|
|
|
HC DRSNG FOAM MEPILEX 6X8" FLEX
|
Facility
|
IP
|
$44.36
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$39.92 |
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Central Health Plan Commercial |
$35.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.74
|
| Rate for Payer: Galaxy Health WC |
$37.71
|
| Rate for Payer: Global Benefits Group Commercial |
$26.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.87
|
| Rate for Payer: Multiplan Commercial |
$33.27
|
| Rate for Payer: Networks By Design Commercial |
$28.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.71
|
|
|
HC DRSNG GAUZE NON-ADHERENT 3X3"
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$5.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.58
|
| 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 |
$0.99
|
| 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 Distinction Transplant |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.81
|
| 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 Media |
$1.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.63
|
| 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: 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
|
| 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 Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
HC DRSNG GAUZE NON-ADHERENT 3X3"
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: 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: 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: 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 GAUZE NON-ADHERENT 3X8"
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Central Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$1.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.65
|
| Rate for Payer: Prime Health Services Commercial |
$2.16
|
|
|
HC DRSNG GAUZE NON-ADHERENT 3X8"
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.50
|
| Rate for Payer: Blue Distinction Transplant |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.24
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Central Health Plan Commercial |
$2.03
|
| Rate for Payer: Cigna of CA HMO |
$1.63
|
| Rate for Payer: Cigna of CA PPO |
$1.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.16
|
| Rate for Payer: Dignity Health Media |
$2.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.02
|
| Rate for Payer: Galaxy Health WC |
$2.16
|
| Rate for Payer: Global Benefits Group Commercial |
$1.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.29
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.90
|
| Rate for Payer: Networks By Design Commercial |
$1.65
|
| Rate for Payer: Prime Health Services Commercial |
$2.16
|
| Rate for Payer: Riverside University Health System MISP |
$1.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.27
|
| Rate for Payer: United Healthcare All Other HMO |
$1.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.16
|
| Rate for Payer: Vantage Medical Group Senior |
$2.16
|
|
|
HC DRSNG GAUZE PETROLATM 3X36"
|
Facility
|
OP
|
$115.22
|
|
|
Service Code
|
CPT A6224
|
| Hospital Charge Code |
901698173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.07
|
| Rate for Payer: Blue Distinction Transplant |
$69.13
|
| Rate for Payer: Blue Shield of California Commercial |
$72.47
|
| Rate for Payer: Blue Shield of California EPN |
$56.34
|
| Rate for Payer: Cash Price |
$51.85
|
| Rate for Payer: Cash Price |
$51.85
|
| Rate for Payer: Central Health Plan Commercial |
$92.18
|
| Rate for Payer: Cigna of CA HMO |
$73.74
|
| Rate for Payer: Cigna of CA PPO |
$85.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.94
|
| Rate for Payer: Dignity Health Media |
$97.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.09
|
| Rate for Payer: Galaxy Health WC |
$97.94
|
| Rate for Payer: Global Benefits Group Commercial |
$69.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$86.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$86.42
|
| Rate for Payer: Networks By Design Commercial |
$74.89
|
| Rate for Payer: Prime Health Services Commercial |
$97.94
|
| Rate for Payer: Riverside University Health System MISP |
$46.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.61
|
| Rate for Payer: United Healthcare All Other HMO |
$57.61
|
| Rate for Payer: United Healthcare HMO Rider |
$57.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.94
|
| Rate for Payer: Vantage Medical Group Senior |
$97.94
|
|
|
HC DRSNG GAUZE PETROLATM 3X36"
|
Facility
|
IP
|
$115.22
|
|
|
Service Code
|
CPT A6224
|
| Hospital Charge Code |
901698173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Cash Price |
$51.85
|
| Rate for Payer: Central Health Plan Commercial |
$92.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.09
|
| Rate for Payer: Galaxy Health WC |
$97.94
|
| Rate for Payer: Global Benefits Group Commercial |
$69.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$86.42
|
| Rate for Payer: Networks By Design Commercial |
$74.89
|
| Rate for Payer: Prime Health Services Commercial |
$97.94
|
|
|
HC DRSNG GAUZE SPONGE 3X3 HRMT
|
Facility
|
IP
|
$0.49
|
|
| Hospital Charge Code |
901692015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
HC DRSNG GAUZE SPONGE 3X3 HRMT
|
Facility
|
OP
|
$0.49
|
|
| Hospital Charge Code |
901692015
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Distinction Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Media |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
HC DRSNG GAUZE XEROFRM 1X8"
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
