|
HC DRSNG MEDIPORE ADHSV 3-1/2"X6"
|
Facility
|
IP
|
$5.90
|
|
|
Service Code
|
CPT A6220
|
| Hospital Charge Code |
901698616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Central Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.02
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.84
|
| Rate for Payer: Prime Health Services Commercial |
$5.02
|
|
|
HC DRSNG MEDIPORE ADHSV 3-1/2"X6"
|
Facility
|
OP
|
$5.90
|
|
|
Service Code
|
CPT A6220
|
| Hospital Charge Code |
901698616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.49
|
| Rate for Payer: Blue Distinction Transplant |
$3.54
|
| Rate for Payer: Blue Shield of California Commercial |
$3.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.89
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Central Health Plan Commercial |
$4.72
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.02
|
| Rate for Payer: Dignity Health Media |
$5.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.02
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.31
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.84
|
| Rate for Payer: Prime Health Services Commercial |
$5.02
|
| Rate for Payer: Riverside University Health System MISP |
$2.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.02
|
| Rate for Payer: Vantage Medical Group Senior |
$5.02
|
|
|
HC DRSNG MEPILEX 4X4
|
Facility
|
IP
|
$18.61
|
|
| Hospital Charge Code |
901602023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$16.75 |
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Central Health Plan Commercial |
$14.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$13.96
|
| Rate for Payer: Networks By Design Commercial |
$12.10
|
| Rate for Payer: Prime Health Services Commercial |
$15.82
|
|
|
HC DRSNG MEPILEX 4X4
|
Facility
|
OP
|
$18.61
|
|
| Hospital Charge Code |
901602023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$16.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.99
|
| Rate for Payer: Blue Distinction Transplant |
$11.17
|
| Rate for Payer: Blue Shield of California Commercial |
$11.71
|
| Rate for Payer: Blue Shield of California EPN |
$9.10
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Central Health Plan Commercial |
$14.89
|
| Rate for Payer: Cigna of CA HMO |
$11.91
|
| Rate for Payer: Cigna of CA PPO |
$13.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.82
|
| Rate for Payer: Dignity Health Media |
$15.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$13.96
|
| Rate for Payer: Networks By Design Commercial |
$12.10
|
| Rate for Payer: Prime Health Services Commercial |
$15.82
|
| Rate for Payer: Riverside University Health System MISP |
$7.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO |
$9.30
|
| Rate for Payer: United Healthcare HMO Rider |
$9.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.82
|
|
|
HC DRSNG MEPILEX BORDER 3X3"
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
HC DRSNG MEPILEX BORDER 3X3"
|
Facility
|
OP
|
$16.56
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.78
|
| Rate for Payer: Blue Distinction Transplant |
$9.94
|
| Rate for Payer: Blue Shield of California Commercial |
$10.42
|
| Rate for Payer: Blue Shield of California EPN |
$8.10
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: Dignity Health Media |
$14.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Riverside University Health System MISP |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
HC DRSNG MEPILEX BORDER 4X10"
|
Facility
|
IP
|
$38.46
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$34.61 |
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Central Health Plan Commercial |
$30.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: Galaxy Health WC |
$32.69
|
| Rate for Payer: Global Benefits Group Commercial |
$23.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$28.84
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$32.69
|
|
|
HC DRSNG MEPILEX BORDER 4X10"
|
Facility
|
OP
|
$38.46
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.72
|
| Rate for Payer: Blue Distinction Transplant |
$23.08
|
| Rate for Payer: Blue Shield of California Commercial |
$24.19
|
| Rate for Payer: Blue Shield of California EPN |
$18.81
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Central Health Plan Commercial |
$30.77
|
| Rate for Payer: Cigna of CA HMO |
$24.61
|
| Rate for Payer: Cigna of CA PPO |
$28.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.69
|
| Rate for Payer: Dignity Health Media |
$32.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.38
|
| Rate for Payer: Galaxy Health WC |
$32.69
|
| Rate for Payer: Global Benefits Group Commercial |
$23.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$28.84
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$32.69
|
| Rate for Payer: Riverside University Health System MISP |
$15.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.23
|
| Rate for Payer: United Healthcare All Other HMO |
$19.23
|
| Rate for Payer: United Healthcare HMO Rider |
$19.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.69
|
| Rate for Payer: Vantage Medical Group Senior |
$32.69
|
|
|
HC DRSNG MEPILEX BORDER 4X12"
|
Facility
|
IP
|
$39.11
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$35.20 |
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Central Health Plan Commercial |
$31.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.64
|
| Rate for Payer: Galaxy Health WC |
$33.24
|
| Rate for Payer: Global Benefits Group Commercial |
$23.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.82
|
| Rate for Payer: Multiplan Commercial |
$29.33
|
| Rate for Payer: Networks By Design Commercial |
$25.42
|
| Rate for Payer: Prime Health Services Commercial |
$33.24
|
|
|
HC DRSNG MEPILEX BORDER 4X12"
|
Facility
|
OP
|
$39.11
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.11
|
| Rate for Payer: Blue Distinction Transplant |
$23.47
|
| Rate for Payer: Blue Shield of California Commercial |
$24.60
|
| Rate for Payer: Blue Shield of California EPN |
$19.12
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Central Health Plan Commercial |
$31.29
|
| Rate for Payer: Cigna of CA HMO |
$25.03
|
| Rate for Payer: Cigna of CA PPO |
$28.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.24
|
| Rate for Payer: Dignity Health Media |
$33.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.64
|
| Rate for Payer: Galaxy Health WC |
$33.24
|
| Rate for Payer: Global Benefits Group Commercial |
$23.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.82
|
| Rate for Payer: Multiplan Commercial |
$29.33
|
| Rate for Payer: Networks By Design Commercial |
$25.42
|
| Rate for Payer: Prime Health Services Commercial |
$33.24
|
| Rate for Payer: Riverside University Health System MISP |
$15.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.56
|
| Rate for Payer: United Healthcare All Other HMO |
$19.56
|
| Rate for Payer: United Healthcare HMO Rider |
$19.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.24
|
| Rate for Payer: Vantage Medical Group Senior |
$33.24
|
|
|
HC DRSNG MEPILEX BORDER 4X8"
|
Facility
|
IP
|
$35.51
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$31.96 |
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Central Health Plan Commercial |
$28.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.18
|
| Rate for Payer: Global Benefits Group Commercial |
$21.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.10
|
| Rate for Payer: Multiplan Commercial |
$26.63
|
| Rate for Payer: Networks By Design Commercial |
$23.08
|
| Rate for Payer: Prime Health Services Commercial |
$30.18
|
|
|
HC DRSNG MEPILEX BORDER 4X8"
|
Facility
|
OP
|
$35.51
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.98
|
| Rate for Payer: Blue Distinction Transplant |
$21.31
|
| Rate for Payer: Blue Shield of California Commercial |
$22.34
|
| Rate for Payer: Blue Shield of California EPN |
$17.36
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Central Health Plan Commercial |
$28.41
|
| Rate for Payer: Cigna of CA HMO |
$22.73
|
| Rate for Payer: Cigna of CA PPO |
$26.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.18
|
| Rate for Payer: Dignity Health Media |
$30.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.18
|
| Rate for Payer: Global Benefits Group Commercial |
$21.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.10
|
| Rate for Payer: Multiplan Commercial |
$26.63
|
| Rate for Payer: Networks By Design Commercial |
$23.08
|
| Rate for Payer: Prime Health Services Commercial |
$30.18
|
| Rate for Payer: Riverside University Health System MISP |
$14.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.76
|
| Rate for Payer: United Healthcare All Other HMO |
$17.76
|
| Rate for Payer: United Healthcare HMO Rider |
$17.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.18
|
| Rate for Payer: Vantage Medical Group Senior |
$30.18
|
|
|
HC DRSNG MEPILEX BORDER 6X6"
|
Facility
|
OP
|
$38.38
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.67
|
| Rate for Payer: Blue Distinction Transplant |
$23.03
|
| Rate for Payer: Blue Shield of California Commercial |
$24.14
|
| Rate for Payer: Blue Shield of California EPN |
$18.77
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Central Health Plan Commercial |
$30.70
|
| Rate for Payer: Cigna of CA HMO |
$24.56
|
| Rate for Payer: Cigna of CA PPO |
$28.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.62
|
| Rate for Payer: Dignity Health Media |
$32.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.35
|
| Rate for Payer: Galaxy Health WC |
$32.62
|
| Rate for Payer: Global Benefits Group Commercial |
$23.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$28.78
|
| Rate for Payer: Networks By Design Commercial |
$24.95
|
| Rate for Payer: Prime Health Services Commercial |
$32.62
|
| Rate for Payer: Riverside University Health System MISP |
$15.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.19
|
| Rate for Payer: United Healthcare All Other HMO |
$19.19
|
| Rate for Payer: United Healthcare HMO Rider |
$19.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.62
|
| Rate for Payer: Vantage Medical Group Senior |
$32.62
|
|
|
HC DRSNG MEPILEX BORDER 6X6"
|
Facility
|
IP
|
$38.38
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$34.54 |
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Central Health Plan Commercial |
$30.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: Galaxy Health WC |
$32.62
|
| Rate for Payer: Global Benefits Group Commercial |
$23.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$28.78
|
| Rate for Payer: Networks By Design Commercial |
$24.95
|
| Rate for Payer: Prime Health Services Commercial |
$32.62
|
|
|
HC DRSNG MEPILEX BORDER 6X8"
|
Facility
|
IP
|
$44.36
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698301
|
|
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 MEPILEX BORDER 6X8"
|
Facility
|
OP
|
$44.36
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698301
|
|
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 MEPILEX BRDR 8.7X9.1"
|
Facility
|
IP
|
$78.64
|
|
| Hospital Charge Code |
901698343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$70.78 |
| Rate for Payer: Cash Price |
$35.39
|
| Rate for Payer: Central Health Plan Commercial |
$62.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.46
|
| Rate for Payer: Galaxy Health WC |
$66.84
|
| Rate for Payer: Global Benefits Group Commercial |
$47.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.73
|
| Rate for Payer: Multiplan Commercial |
$58.98
|
| Rate for Payer: Networks By Design Commercial |
$51.12
|
| Rate for Payer: Prime Health Services Commercial |
$66.84
|
|
|
HC DRSNG MEPILEX BRDR 8.7X9.1"
|
Facility
|
OP
|
$78.64
|
|
| Hospital Charge Code |
901698343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$70.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.46
|
| Rate for Payer: Blue Distinction Transplant |
$47.18
|
| Rate for Payer: Blue Shield of California Commercial |
$49.46
|
| Rate for Payer: Blue Shield of California EPN |
$38.45
|
| Rate for Payer: Cash Price |
$35.39
|
| Rate for Payer: Central Health Plan Commercial |
$62.91
|
| Rate for Payer: Cigna of CA HMO |
$50.33
|
| Rate for Payer: Cigna of CA PPO |
$58.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.84
|
| Rate for Payer: Dignity Health Media |
$66.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.46
|
| Rate for Payer: Galaxy Health WC |
$66.84
|
| Rate for Payer: Global Benefits Group Commercial |
$47.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$58.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.73
|
| Rate for Payer: Multiplan Commercial |
$58.98
|
| Rate for Payer: Networks By Design Commercial |
$51.12
|
| Rate for Payer: Prime Health Services Commercial |
$66.84
|
| Rate for Payer: Riverside University Health System MISP |
$31.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.32
|
| Rate for Payer: United Healthcare All Other HMO |
$39.32
|
| Rate for Payer: United Healthcare HMO Rider |
$39.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.84
|
| Rate for Payer: Vantage Medical Group Senior |
$66.84
|
|
|
HC DRSNG MEPILEX BRDR FLEX 1.6X2"
|
Facility
|
OP
|
$10.50
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.20
|
| Rate for Payer: Blue Distinction Transplant |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.60
|
| Rate for Payer: Blue Shield of California EPN |
$5.13
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Central Health Plan Commercial |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.92
|
| Rate for Payer: Dignity Health Media |
$8.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.20
|
| Rate for Payer: Galaxy Health WC |
$8.92
|
| Rate for Payer: Global Benefits Group Commercial |
$6.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.88
|
| Rate for Payer: Networks By Design Commercial |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$8.92
|
| Rate for Payer: Riverside University Health System MISP |
$4.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.92
|
| Rate for Payer: Vantage Medical Group Senior |
$8.92
|
|
|
HC DRSNG MEPILEX BRDR FLEX 1.6X2"
|
Facility
|
IP
|
$10.50
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Central Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.20
|
| Rate for Payer: Galaxy Health WC |
$8.92
|
| Rate for Payer: Global Benefits Group Commercial |
$6.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.88
|
| Rate for Payer: Networks By Design Commercial |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$8.92
|
|
|
HC DRSNG MEPILEX BRDR LITE 1.6X2"
|
Facility
|
IP
|
$10.50
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Central Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.20
|
| Rate for Payer: Galaxy Health WC |
$8.92
|
| Rate for Payer: Global Benefits Group Commercial |
$6.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.88
|
| Rate for Payer: Networks By Design Commercial |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$8.92
|
|
|
HC DRSNG MEPILEX BRDR LITE 1.6X2"
|
Facility
|
OP
|
$10.50
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.20
|
| Rate for Payer: Blue Distinction Transplant |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.60
|
| Rate for Payer: Blue Shield of California EPN |
$5.13
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Central Health Plan Commercial |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.92
|
| Rate for Payer: Dignity Health Media |
$8.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.20
|
| Rate for Payer: Galaxy Health WC |
$8.92
|
| Rate for Payer: Global Benefits Group Commercial |
$6.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.88
|
| Rate for Payer: Networks By Design Commercial |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$8.92
|
| Rate for Payer: Riverside University Health System MISP |
$4.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.92
|
| Rate for Payer: Vantage Medical Group Senior |
$8.92
|
|
|
HC DRSNG MEPILEX BRDR LITE 2X5"
|
Facility
|
IP
|
$12.63
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$11.37 |
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Central Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$9.47
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
|
|
HC DRSNG MEPILEX BRDR LITE 2X5"
|
Facility
|
OP
|
$12.63
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901698305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.46
|
| Rate for Payer: Blue Distinction Transplant |
$7.58
|
| Rate for Payer: Blue Shield of California Commercial |
$7.94
|
| Rate for Payer: Blue Shield of California EPN |
$6.18
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Central Health Plan Commercial |
$10.10
|
| Rate for Payer: Cigna of CA HMO |
$8.08
|
| Rate for Payer: Cigna of CA PPO |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.74
|
| Rate for Payer: Dignity Health Media |
$10.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$9.47
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
| Rate for Payer: Riverside University Health System MISP |
$5.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.32
|
| Rate for Payer: United Healthcare All Other HMO |
$6.32
|
| Rate for Payer: United Healthcare HMO Rider |
$6.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X10"
|
Facility
|
IP
|
$186.55
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$167.90 |
| Rate for Payer: Cash Price |
$83.95
|
| Rate for Payer: Central Health Plan Commercial |
$149.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.62
|
| Rate for Payer: Galaxy Health WC |
$158.57
|
| Rate for Payer: Global Benefits Group Commercial |
$111.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.31
|
| Rate for Payer: Multiplan Commercial |
$139.91
|
| Rate for Payer: Networks By Design Commercial |
$121.26
|
| Rate for Payer: Prime Health Services Commercial |
$158.57
|
|
