|
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 |
$37.71 |
| Rate for Payer: Adventist Health Commercial |
$8.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.10
|
| 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 |
$33.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.24
|
| Rate for Payer: Cash Price |
$24.40
|
| 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 Medi-Cal |
$37.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.74
|
| Rate for Payer: EPIC Health Plan Senior |
$17.74
|
| Rate for Payer: Galaxy Health WC |
$37.71
|
| Rate for Payer: Global Benefits Group Commercial |
$26.62
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$27.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.05
|
| Rate for Payer: Multiplan Commercial |
$35.49
|
| Rate for Payer: Networks By Design Commercial |
$28.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.71
|
| 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 Commercial/Exchange |
$37.71
|
| 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
|
$80.03
|
|
| Hospital Charge Code |
901698343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.01 |
| Max. Negotiated Rate |
$68.03 |
| Rate for Payer: Adventist Health Commercial |
$16.01
|
| Rate for Payer: Cash Price |
$44.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.01
|
| Rate for Payer: EPIC Health Plan Senior |
$32.01
|
| Rate for Payer: Galaxy Health WC |
$68.03
|
| Rate for Payer: Global Benefits Group Commercial |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.21
|
| Rate for Payer: Multiplan Commercial |
$64.02
|
| Rate for Payer: Networks By Design Commercial |
$52.02
|
| Rate for Payer: Prime Health Services Commercial |
$68.03
|
|
|
HC DRSNG MEPILEX BRDR 8.7X9.1"
|
Facility
|
OP
|
$80.03
|
|
| Hospital Charge Code |
901698343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.01 |
| Max. Negotiated Rate |
$68.03 |
| Rate for Payer: Vantage Medical Group Senior |
$68.03
|
| Rate for Payer: Adventist Health Commercial |
$16.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.15
|
| Rate for Payer: Cash Price |
$44.02
|
| Rate for Payer: Cigna of CA HMO |
$51.22
|
| Rate for Payer: Cigna of CA PPO |
$59.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.01
|
| Rate for Payer: EPIC Health Plan Senior |
$32.01
|
| Rate for Payer: Galaxy Health WC |
$68.03
|
| Rate for Payer: Global Benefits Group Commercial |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.02
|
| Rate for Payer: Multiplan Commercial |
$64.02
|
| Rate for Payer: Networks By Design Commercial |
$52.02
|
| Rate for Payer: Prime Health Services Commercial |
$68.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.02
|
| Rate for Payer: United Healthcare All Other HMO |
$40.02
|
| Rate for Payer: United Healthcare HMO Rider |
$40.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.03
|
|
|
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 |
$8.93 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.45
|
| Rate for Payer: Cash Price |
$5.78
|
| 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 |
$8.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.20
|
| Rate for Payer: Galaxy Health WC |
$8.93
|
| Rate for Payer: Global Benefits Group Commercial |
$6.30
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.35
|
| Rate for Payer: Multiplan Commercial |
$8.40
|
| Rate for Payer: Networks By Design Commercial |
$6.83
|
| Rate for Payer: Prime Health Services Commercial |
$8.93
|
| 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 Commercial/Exchange |
$8.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.93
|
| Rate for Payer: Vantage Medical Group Senior |
$8.93
|
|
|
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 |
$8.93 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.20
|
| Rate for Payer: Galaxy Health WC |
$8.93
|
| Rate for Payer: Global Benefits Group Commercial |
$6.30
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$8.40
|
| Rate for Payer: Networks By Design Commercial |
$6.83
|
| Rate for Payer: Prime Health Services Commercial |
$8.93
|
|
|
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 |
$8.93 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.20
|
| Rate for Payer: Galaxy Health WC |
$8.93
|
| Rate for Payer: Global Benefits Group Commercial |
$6.30
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Multiplan Commercial |
$8.40
|
| Rate for Payer: Networks By Design Commercial |
$6.83
|
| Rate for Payer: Prime Health Services Commercial |
$8.93
|
|
|
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 |
$8.93 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.45
|
| Rate for Payer: Cash Price |
$5.78
|
| 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 |
$8.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4.20
|
| Rate for Payer: Galaxy Health WC |
$8.93
|
| Rate for Payer: Global Benefits Group Commercial |
$6.30
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.35
|
| Rate for Payer: Multiplan Commercial |
$8.40
|
| Rate for Payer: Networks By Design Commercial |
$6.83
|
| Rate for Payer: Prime Health Services Commercial |
$8.93
|
| 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 Commercial/Exchange |
$8.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.93
|
| Rate for Payer: Vantage Medical Group Senior |
$8.93
|
|
|
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 |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.28
|
| 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 |
$9.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.76
|
| Rate for Payer: Cash Price |
$6.95
|
| 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 Medi-Cal |
$10.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.58
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.84
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
| 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 Commercial/Exchange |
$10.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
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 |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.58
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
|
|
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 |
$158.57 |
| Rate for Payer: Adventist Health Commercial |
$37.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.36
|
| 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 |
$139.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.56
|
| Rate for Payer: Cash Price |
$102.60
|
| 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 Medi-Cal |
$158.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.62
|
| Rate for Payer: EPIC Health Plan Senior |
$74.62
|
| Rate for Payer: Galaxy Health WC |
$158.57
|
| Rate for Payer: Global Benefits Group Commercial |
$111.93
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$115.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130.59
|
| Rate for Payer: Multiplan Commercial |
$149.24
|
| Rate for Payer: Networks By Design Commercial |
$121.26
|
| Rate for Payer: Prime Health Services Commercial |
$158.57
|
| 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 Commercial/Exchange |
$158.57
|
| 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 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 |
$158.57 |
| Rate for Payer: Adventist Health Commercial |
$37.31
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.62
|
| Rate for Payer: EPIC Health Plan Senior |
$74.62
|
| Rate for Payer: Galaxy Health WC |
$158.57
|
| Rate for Payer: Global Benefits Group Commercial |
$111.93
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$115.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$149.24
|
| Rate for Payer: Networks By Design Commercial |
$121.26
|
| Rate for Payer: Prime Health Services Commercial |
$158.57
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X12"
|
Facility
|
IP
|
$224.77
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.95 |
| Max. Negotiated Rate |
$191.05 |
| Rate for Payer: Adventist Health Commercial |
$44.95
|
| Rate for Payer: Cash Price |
$123.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.91
|
| Rate for Payer: EPIC Health Plan Senior |
$89.91
|
| Rate for Payer: Galaxy Health WC |
$191.05
|
| Rate for Payer: Global Benefits Group Commercial |
$134.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.94
|
| Rate for Payer: Multiplan Commercial |
$179.82
|
| Rate for Payer: Networks By Design Commercial |
$146.10
|
| Rate for Payer: Prime Health Services Commercial |
$191.05
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X12"
|
Facility
|
OP
|
$224.77
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.95 |
| Max. Negotiated Rate |
$191.05 |
| Rate for Payer: Adventist Health Commercial |
$44.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.03
|
| Rate for Payer: Cash Price |
$123.62
|
| Rate for Payer: Cigna of CA HMO |
$143.85
|
| Rate for Payer: Cigna of CA PPO |
$166.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.91
|
| Rate for Payer: EPIC Health Plan Senior |
$89.91
|
| Rate for Payer: Galaxy Health WC |
$191.05
|
| Rate for Payer: Global Benefits Group Commercial |
$134.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.34
|
| Rate for Payer: Multiplan Commercial |
$179.82
|
| Rate for Payer: Networks By Design Commercial |
$146.10
|
| Rate for Payer: Prime Health Services Commercial |
$191.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.39
|
| Rate for Payer: United Healthcare All Other HMO |
$112.39
|
| Rate for Payer: United Healthcare HMO Rider |
$112.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.05
|
| Rate for Payer: Vantage Medical Group Senior |
$191.05
|
|
|
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 |
$49.35 |
| Max. Negotiated Rate |
$209.74 |
| Rate for Payer: Adventist Health Commercial |
$49.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.84
|
| 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 |
$185.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.53
|
| Rate for Payer: Cash Price |
$135.71
|
| Rate for Payer: Cigna of CA HMO |
$157.92
|
| Rate for Payer: Cigna of CA PPO |
$182.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.70
|
| Rate for Payer: EPIC Health Plan Senior |
$98.70
|
| Rate for Payer: Galaxy Health WC |
$209.74
|
| Rate for Payer: Global Benefits Group Commercial |
$148.05
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$152.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.72
|
| Rate for Payer: Multiplan Commercial |
$197.40
|
| Rate for Payer: Networks By Design Commercial |
$160.39
|
| Rate for Payer: Prime Health Services Commercial |
$209.74
|
| 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 Commercial/Exchange |
$209.74
|
| 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 |
$209.74 |
| Rate for Payer: Adventist Health Commercial |
$49.35
|
| Rate for Payer: Cash Price |
$135.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.70
|
| Rate for Payer: EPIC Health Plan Senior |
$98.70
|
| Rate for Payer: Galaxy Health WC |
$209.74
|
| Rate for Payer: Global Benefits Group Commercial |
$148.05
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$152.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.22
|
| Rate for Payer: Multiplan Commercial |
$197.40
|
| 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
|
OP
|
$152.00
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.70
|
| 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 |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.34
|
| Rate for Payer: Cash Price |
$83.60
|
| 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 Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| 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 Commercial/Exchange |
$129.20
|
| 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 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 |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$147.26 |
| Rate for Payer: Adventist Health Commercial |
$34.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.63
|
| 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 |
$129.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.39
|
| Rate for Payer: Cash Price |
$95.29
|
| Rate for Payer: Cigna of CA HMO |
$110.88
|
| Rate for Payer: Cigna of CA PPO |
$128.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.30
|
| Rate for Payer: EPIC Health Plan Senior |
$69.30
|
| Rate for Payer: Galaxy Health WC |
$147.26
|
| Rate for Payer: Global Benefits Group Commercial |
$103.95
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$107.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.28
|
| Rate for Payer: Multiplan Commercial |
$138.60
|
| Rate for Payer: Networks By Design Commercial |
$112.61
|
| Rate for Payer: Prime Health Services Commercial |
$147.26
|
| 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 Commercial/Exchange |
$147.26
|
| 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 |
$147.26 |
| Rate for Payer: Adventist Health Commercial |
$34.65
|
| Rate for Payer: Cash Price |
$95.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.30
|
| Rate for Payer: EPIC Health Plan Senior |
$69.30
|
| Rate for Payer: Galaxy Health WC |
$147.26
|
| Rate for Payer: Global Benefits Group Commercial |
$103.95
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$107.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.58
|
| Rate for Payer: Multiplan Commercial |
$138.60
|
| Rate for Payer: Networks By Design Commercial |
$112.61
|
| Rate for Payer: Prime Health Services Commercial |
$147.26
|
|
|
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 |
$40.43 |
| Rate for Payer: Adventist Health Commercial |
$9.51
|
| Rate for Payer: Cash Price |
$26.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$19.02
|
| Rate for Payer: Galaxy Health WC |
$40.43
|
| Rate for Payer: Global Benefits Group Commercial |
$28.54
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$29.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.41
|
| Rate for Payer: Multiplan Commercial |
$38.05
|
| Rate for Payer: Networks By Design Commercial |
$30.91
|
| Rate for Payer: Prime Health Services Commercial |
$40.43
|
|
|
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 |
$40.43 |
| Rate for Payer: Adventist Health Commercial |
$9.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.19
|
| 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 |
$35.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.21
|
| Rate for Payer: Cash Price |
$26.16
|
| 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 Medi-Cal |
$40.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$19.02
|
| Rate for Payer: Galaxy Health WC |
$40.43
|
| Rate for Payer: Global Benefits Group Commercial |
$28.54
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$29.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.29
|
| Rate for Payer: Multiplan Commercial |
$38.05
|
| Rate for Payer: Networks By Design Commercial |
$30.91
|
| Rate for Payer: Prime Health Services Commercial |
$40.43
|
| 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 Commercial/Exchange |
$40.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.43
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$63.49 |
| Rate for Payer: Adventist Health Commercial |
$14.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.87
|
| Rate for Payer: Cash Price |
$41.09
|
| 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 |
$63.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.88
|
| Rate for Payer: EPIC Health Plan Senior |
$29.88
|
| Rate for Payer: Galaxy Health WC |
$63.49
|
| Rate for Payer: Global Benefits Group Commercial |
$44.82
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$46.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.29
|
| Rate for Payer: Multiplan Commercial |
$59.76
|
| Rate for Payer: Networks By Design Commercial |
$48.55
|
| Rate for Payer: Prime Health Services Commercial |
$63.49
|
| 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 Commercial/Exchange |
$63.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.49
|
| Rate for Payer: Vantage Medical Group Senior |
$63.49
|
|
|
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 |
$63.49 |
| Rate for Payer: Adventist Health Commercial |
$14.94
|
| Rate for Payer: Cash Price |
$41.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.88
|
| Rate for Payer: EPIC Health Plan Senior |
$29.88
|
| Rate for Payer: Galaxy Health WC |
$63.49
|
| Rate for Payer: Global Benefits Group Commercial |
$44.82
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$46.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$59.76
|
| Rate for Payer: Networks By Design Commercial |
$48.55
|
| Rate for Payer: Prime Health Services Commercial |
$63.49
|
|
|
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 |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| 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 |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
