|
HC DRSNG MEPILEX POST-OP AG 4X10"
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.21
|
| Rate for Payer: Blue Distinction Transplant |
$111.93
|
| Rate for Payer: Blue Shield of California Commercial |
$117.34
|
| Rate for Payer: Blue Shield of California EPN |
$91.22
|
| Rate for Payer: Cash Price |
$83.95
|
| Rate for Payer: Cash Price |
$83.95
|
| Rate for Payer: Central Health Plan Commercial |
$149.24
|
| Rate for Payer: Cigna of CA HMO |
$119.39
|
| Rate for Payer: Cigna of CA PPO |
$138.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.57
|
| Rate for Payer: Dignity Health Media |
$158.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$139.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.29
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$74.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.28
|
| Rate for Payer: United Healthcare All Other HMO |
$93.28
|
| Rate for Payer: United Healthcare HMO Rider |
$93.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.57
|
| Rate for Payer: Vantage Medical Group Senior |
$158.57
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X12"
|
Facility
|
OP
|
$205.45
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$184.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$113.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.38
|
| Rate for Payer: Blue Distinction Transplant |
$123.27
|
| Rate for Payer: Blue Shield of California Commercial |
$129.23
|
| Rate for Payer: Blue Shield of California EPN |
$100.47
|
| Rate for Payer: Cash Price |
$92.45
|
| Rate for Payer: Cash Price |
$92.45
|
| Rate for Payer: Central Health Plan Commercial |
$164.36
|
| Rate for Payer: Cigna of CA HMO |
$131.49
|
| Rate for Payer: Cigna of CA PPO |
$152.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.63
|
| Rate for Payer: Dignity Health Media |
$174.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$174.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$82.18
|
| Rate for Payer: Galaxy Health WC |
$174.63
|
| Rate for Payer: Global Benefits Group Commercial |
$123.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$184.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$154.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$71.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.09
|
| Rate for Payer: Multiplan Commercial |
$154.09
|
| Rate for Payer: Networks By Design Commercial |
$133.54
|
| Rate for Payer: Prime Health Services Commercial |
$174.63
|
| Rate for Payer: Riverside University Health System MISP |
$82.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Other HMO |
$102.72
|
| Rate for Payer: United Healthcare HMO Rider |
$102.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$174.63
|
| Rate for Payer: Vantage Medical Group Senior |
$174.63
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X12"
|
Facility
|
IP
|
$205.45
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$184.90 |
| Rate for Payer: Cash Price |
$92.45
|
| Rate for Payer: Central Health Plan Commercial |
$164.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.18
|
| Rate for Payer: Galaxy Health WC |
$174.63
|
| Rate for Payer: Global Benefits Group Commercial |
$123.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$184.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.09
|
| Rate for Payer: Multiplan Commercial |
$154.09
|
| Rate for Payer: Networks By Design Commercial |
$133.54
|
| Rate for Payer: Prime Health Services Commercial |
$174.63
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X14"
|
Facility
|
OP
|
$246.75
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.78
|
| Rate for Payer: Blue Distinction Transplant |
$148.05
|
| Rate for Payer: Blue Shield of California Commercial |
$155.21
|
| Rate for Payer: Blue Shield of California EPN |
$120.66
|
| Rate for Payer: Cash Price |
$111.04
|
| Rate for Payer: Cash Price |
$111.04
|
| Rate for Payer: Central Health Plan Commercial |
$197.40
|
| Rate for Payer: Cigna of CA HMO |
$157.92
|
| Rate for Payer: Cigna of CA PPO |
$182.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.74
|
| Rate for Payer: Dignity Health Media |
$209.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$98.70
|
| Rate for Payer: Galaxy Health WC |
$209.74
|
| Rate for Payer: Global Benefits Group Commercial |
$148.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$185.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.35
|
| Rate for Payer: Multiplan Commercial |
$185.06
|
| Rate for Payer: Networks By Design Commercial |
$160.39
|
| Rate for Payer: Prime Health Services Commercial |
$209.74
|
| Rate for Payer: Riverside University Health System MISP |
$98.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.74
|
| Rate for Payer: Vantage Medical Group Senior |
$209.74
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X14"
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Cash Price |
$111.04
|
| Rate for Payer: Central Health Plan Commercial |
$197.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.70
|
| Rate for Payer: Galaxy Health WC |
$209.74
|
| Rate for Payer: Global Benefits Group Commercial |
$148.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.35
|
| Rate for Payer: Multiplan Commercial |
$185.06
|
| Rate for Payer: Networks By Design Commercial |
$160.39
|
| Rate for Payer: Prime Health Services Commercial |
$209.74
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X6"
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X6"
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.80
|
| Rate for Payer: Blue Distinction Transplant |
$91.20
|
| Rate for Payer: Blue Shield of California Commercial |
$95.61
|
| Rate for Payer: Blue Shield of California EPN |
$74.33
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Media |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$114.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X8"
|
Facility
|
OP
|
$173.25
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$155.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$147.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.36
|
| Rate for Payer: Blue Distinction Transplant |
$103.95
|
| Rate for Payer: Blue Shield of California Commercial |
$108.97
|
| Rate for Payer: Blue Shield of California EPN |
$84.72
|
| Rate for Payer: Cash Price |
$77.96
|
| Rate for Payer: Cash Price |
$77.96
|
| Rate for Payer: Central Health Plan Commercial |
$138.60
|
| Rate for Payer: Cigna of CA HMO |
$110.88
|
| Rate for Payer: Cigna of CA PPO |
$128.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.26
|
| Rate for Payer: Dignity Health Media |
$147.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.30
|
| Rate for Payer: Galaxy Health WC |
$147.26
|
| Rate for Payer: Global Benefits Group Commercial |
$103.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$129.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.65
|
| Rate for Payer: Multiplan Commercial |
$129.94
|
| Rate for Payer: Networks By Design Commercial |
$112.61
|
| Rate for Payer: Prime Health Services Commercial |
$147.26
|
| Rate for Payer: Riverside University Health System MISP |
$69.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.62
|
| Rate for Payer: United Healthcare All Other HMO |
$86.62
|
| Rate for Payer: United Healthcare HMO Rider |
$86.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.26
|
| Rate for Payer: Vantage Medical Group Senior |
$147.26
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X8"
|
Facility
|
IP
|
$173.25
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$155.92 |
| Rate for Payer: Cash Price |
$77.96
|
| Rate for Payer: Central Health Plan Commercial |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.30
|
| Rate for Payer: Galaxy Health WC |
$147.26
|
| Rate for Payer: Global Benefits Group Commercial |
$103.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.65
|
| Rate for Payer: Multiplan Commercial |
$129.94
|
| Rate for Payer: Networks By Design Commercial |
$112.61
|
| Rate for Payer: Prime Health Services Commercial |
$147.26
|
|
|
HC DRSNG MEPILEX SACRAL 7X7
|
Facility
|
OP
|
$47.56
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$42.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.10
|
| Rate for Payer: Blue Distinction Transplant |
$28.54
|
| Rate for Payer: Blue Shield of California Commercial |
$29.92
|
| Rate for Payer: Blue Shield of California EPN |
$23.26
|
| Rate for Payer: Cash Price |
$21.40
|
| Rate for Payer: Cash Price |
$21.40
|
| Rate for Payer: Central Health Plan Commercial |
$38.05
|
| Rate for Payer: Cigna of CA HMO |
$30.44
|
| Rate for Payer: Cigna of CA PPO |
$35.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.43
|
| Rate for Payer: Dignity Health Media |
$40.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.02
|
| Rate for Payer: Galaxy Health WC |
$40.43
|
| Rate for Payer: Global Benefits Group Commercial |
$28.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$35.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.51
|
| Rate for Payer: Multiplan Commercial |
$35.67
|
| Rate for Payer: Networks By Design Commercial |
$30.91
|
| Rate for Payer: Prime Health Services Commercial |
$40.43
|
| Rate for Payer: Riverside University Health System MISP |
$19.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.78
|
| Rate for Payer: United Healthcare All Other HMO |
$23.78
|
| Rate for Payer: United Healthcare HMO Rider |
$23.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.43
|
| Rate for Payer: Vantage Medical Group Senior |
$40.43
|
|
|
HC DRSNG MEPILEX SACRAL 7X7
|
Facility
|
IP
|
$47.56
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$42.80 |
| Rate for Payer: Cash Price |
$21.40
|
| Rate for Payer: Central Health Plan Commercial |
$38.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: Galaxy Health WC |
$40.43
|
| Rate for Payer: Global Benefits Group Commercial |
$28.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.51
|
| Rate for Payer: Multiplan Commercial |
$35.67
|
| Rate for Payer: Networks By Design Commercial |
$30.91
|
| Rate for Payer: Prime Health Services Commercial |
$40.43
|
|
|
HC DRSNG MEPILEX SACRAL 9X9
|
Facility
|
OP
|
$74.70
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$67.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.13
|
| Rate for Payer: Blue Distinction Transplant |
$44.82
|
| Rate for Payer: Blue Shield of California Commercial |
$46.99
|
| Rate for Payer: Blue Shield of California EPN |
$36.53
|
| Rate for Payer: Cash Price |
$33.62
|
| Rate for Payer: Cash Price |
$33.62
|
| Rate for Payer: Central Health Plan Commercial |
$59.76
|
| Rate for Payer: Cigna of CA HMO |
$47.81
|
| Rate for Payer: Cigna of CA PPO |
$55.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.50
|
| Rate for Payer: Dignity Health Media |
$63.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.88
|
| Rate for Payer: Galaxy Health WC |
$63.50
|
| Rate for Payer: Global Benefits Group Commercial |
$44.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.23
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$56.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.94
|
| Rate for Payer: Multiplan Commercial |
$56.02
|
| Rate for Payer: Networks By Design Commercial |
$48.56
|
| Rate for Payer: Prime Health Services Commercial |
$63.50
|
| Rate for Payer: Riverside University Health System MISP |
$29.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.35
|
| Rate for Payer: United Healthcare All Other HMO |
$37.35
|
| Rate for Payer: United Healthcare HMO Rider |
$37.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.50
|
| Rate for Payer: Vantage Medical Group Senior |
$63.50
|
|
|
HC DRSNG MEPILEX SACRAL 9X9
|
Facility
|
IP
|
$74.70
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$67.23 |
| Rate for Payer: Cash Price |
$33.62
|
| Rate for Payer: Central Health Plan Commercial |
$59.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.88
|
| Rate for Payer: Galaxy Health WC |
$63.50
|
| Rate for Payer: Global Benefits Group Commercial |
$44.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.94
|
| Rate for Payer: Multiplan Commercial |
$56.02
|
| Rate for Payer: Networks By Design Commercial |
$48.56
|
| Rate for Payer: Prime Health Services Commercial |
$63.50
|
|
|
HC DRSNG MEPILEX SACRUM 9.2X9.2
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901602024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC DRSNG MEPILEX SACRUM 9.2X9.2
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901602024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRSNG MEPILEX TRANSFER AG 8X8
|
Facility
|
OP
|
$256.69
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901607630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.34 |
| Max. Negotiated Rate |
$231.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$218.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$141.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.65
|
| Rate for Payer: Blue Distinction Transplant |
$154.01
|
| Rate for Payer: Blue Shield of California Commercial |
$161.46
|
| Rate for Payer: Blue Shield of California EPN |
$125.52
|
| Rate for Payer: Cash Price |
$115.51
|
| Rate for Payer: Cash Price |
$115.51
|
| Rate for Payer: Central Health Plan Commercial |
$205.35
|
| Rate for Payer: Cigna of CA HMO |
$164.28
|
| Rate for Payer: Cigna of CA PPO |
$189.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$218.19
|
| Rate for Payer: Dignity Health Media |
$218.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.68
|
| Rate for Payer: Galaxy Health WC |
$218.19
|
| Rate for Payer: Global Benefits Group Commercial |
$154.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$231.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$192.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$171.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.34
|
| Rate for Payer: Multiplan Commercial |
$192.52
|
| Rate for Payer: Networks By Design Commercial |
$166.85
|
| Rate for Payer: Prime Health Services Commercial |
$218.19
|
| Rate for Payer: Riverside University Health System MISP |
$102.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$154.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$154.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.34
|
| Rate for Payer: United Healthcare All Other HMO |
$128.34
|
| Rate for Payer: United Healthcare HMO Rider |
$128.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.19
|
| Rate for Payer: Vantage Medical Group Senior |
$218.19
|
|
|
HC DRSNG MEPILEX TRANSFER AG 8X8
|
Facility
|
IP
|
$256.69
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901607630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.34 |
| Max. Negotiated Rate |
$231.02 |
| Rate for Payer: Cash Price |
$115.51
|
| Rate for Payer: Central Health Plan Commercial |
$205.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.68
|
| Rate for Payer: Galaxy Health WC |
$218.19
|
| Rate for Payer: Global Benefits Group Commercial |
$154.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$231.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$171.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.34
|
| Rate for Payer: Multiplan Commercial |
$192.52
|
| Rate for Payer: Networks By Design Commercial |
$166.85
|
| Rate for Payer: Prime Health Services Commercial |
$218.19
|
|
|
HC DRSNG MEPITEL 1 NON-ADH 4X7"
|
Facility
|
OP
|
$65.35
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.61
|
| Rate for Payer: Blue Distinction Transplant |
$39.21
|
| Rate for Payer: Blue Shield of California Commercial |
$41.11
|
| Rate for Payer: Blue Shield of California EPN |
$31.96
|
| Rate for Payer: Cash Price |
$29.41
|
| Rate for Payer: Cash Price |
$29.41
|
| Rate for Payer: Central Health Plan Commercial |
$52.28
|
| Rate for Payer: Cigna of CA HMO |
$41.82
|
| Rate for Payer: Cigna of CA PPO |
$48.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.55
|
| Rate for Payer: Dignity Health Media |
$55.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.14
|
| Rate for Payer: Galaxy Health WC |
$55.55
|
| Rate for Payer: Global Benefits Group Commercial |
$39.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$49.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.07
|
| Rate for Payer: Multiplan Commercial |
$49.01
|
| Rate for Payer: Networks By Design Commercial |
$42.48
|
| Rate for Payer: Prime Health Services Commercial |
$55.55
|
| Rate for Payer: Riverside University Health System MISP |
$26.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.68
|
| Rate for Payer: United Healthcare All Other HMO |
$32.68
|
| Rate for Payer: United Healthcare HMO Rider |
$32.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Vantage Medical Group Senior |
$55.55
|
|
|
HC DRSNG MEPITEL 1 NON-ADH 4X7"
|
Facility
|
IP
|
$65.35
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Cash Price |
$29.41
|
| Rate for Payer: Central Health Plan Commercial |
$52.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.14
|
| Rate for Payer: Galaxy Health WC |
$55.55
|
| Rate for Payer: Global Benefits Group Commercial |
$39.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.07
|
| Rate for Payer: Multiplan Commercial |
$49.01
|
| Rate for Payer: Networks By Design Commercial |
$42.48
|
| Rate for Payer: Prime Health Services Commercial |
$55.55
|
|
|
HC DRSNG MEPITEL 4 X 7.2" NON-ADH
|
Facility
|
IP
|
$63.06
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$56.75 |
| Rate for Payer: Cash Price |
$28.38
|
| Rate for Payer: Central Health Plan Commercial |
$50.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.22
|
| Rate for Payer: Galaxy Health WC |
$53.60
|
| Rate for Payer: Global Benefits Group Commercial |
$37.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.61
|
| Rate for Payer: Multiplan Commercial |
$47.30
|
| Rate for Payer: Networks By Design Commercial |
$40.99
|
| Rate for Payer: Prime Health Services Commercial |
$53.60
|
|
|
HC DRSNG MEPITEL 4 X 7.2" NON-ADH
|
Facility
|
OP
|
$63.06
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698589
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$56.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.26
|
| Rate for Payer: Blue Distinction Transplant |
$37.84
|
| Rate for Payer: Blue Shield of California Commercial |
$39.66
|
| Rate for Payer: Blue Shield of California EPN |
$30.84
|
| Rate for Payer: Cash Price |
$28.38
|
| Rate for Payer: Cash Price |
$28.38
|
| Rate for Payer: Central Health Plan Commercial |
$50.45
|
| Rate for Payer: Cigna of CA HMO |
$40.36
|
| Rate for Payer: Cigna of CA PPO |
$46.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.60
|
| Rate for Payer: Dignity Health Media |
$53.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.22
|
| Rate for Payer: Galaxy Health WC |
$53.60
|
| Rate for Payer: Global Benefits Group Commercial |
$37.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.61
|
| Rate for Payer: Multiplan Commercial |
$47.30
|
| Rate for Payer: Networks By Design Commercial |
$40.99
|
| Rate for Payer: Prime Health Services Commercial |
$53.60
|
| Rate for Payer: Riverside University Health System MISP |
$25.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$31.53
|
| Rate for Payer: United Healthcare HMO Rider |
$31.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.60
|
| Rate for Payer: Vantage Medical Group Senior |
$53.60
|
|
|
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: Aetna of CA HMO/PPO |
$8.47
|
| 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 |
$18.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.39
|
| Rate for Payer: Blue Distinction Transplant |
$20.71
|
| Rate for Payer: Blue Shield of California Commercial |
$21.71
|
| Rate for Payer: Blue Shield of California EPN |
$16.88
|
| Rate for Payer: Cash Price |
$15.53
|
| 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 Media |
$29.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$25.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.08
|
| 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: 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
|
| 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 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: 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: 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: 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
|
$1.72
|
|
| Hospital Charge Code |
901600312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.02
|
| Rate for Payer: Blue Distinction Transplant |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.10
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Media |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Riverside University Health System MISP |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
HC DRSNG NON-ADHERENT 3 X 3
|
Facility
|
IP
|
$1.72
|
|
| Hospital Charge Code |
901600312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
|
