|
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 |
$7.37 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.79
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cash Price |
$2.66
|
| 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 |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| 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 Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
HC DRSNG MEPILEX 4X4
|
Facility
|
OP
|
$18.61
|
|
| Hospital Charge Code |
901602023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.21
|
| 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 |
$13.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.94
|
| Rate for Payer: Cash Price |
$8.37
|
| 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 Medi-Cal |
$15.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.03
|
| Rate for Payer: Multiplan Commercial |
$14.89
|
| Rate for Payer: Networks By Design Commercial |
$12.10
|
| Rate for Payer: Prime Health Services Commercial |
$15.82
|
| 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 Commercial/Exchange |
$15.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.82
|
|
|
HC DRSNG MEPILEX 4X4
|
Facility
|
IP
|
$18.61
|
|
| Hospital Charge Code |
901602023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.47
|
| Rate for Payer: Multiplan Commercial |
$14.89
|
| Rate for Payer: Networks By Design Commercial |
$12.10
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$14.08 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$13.25
|
| 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 |
$27.67 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.67
|
| 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 |
$12.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.63
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cash Price |
$7.45
|
| 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 Medi-Cal |
$14.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$13.25
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| 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 Commercial/Exchange |
$14.08
|
| 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
|
OP
|
$38.46
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$45.81 |
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cigna of CA HMO |
$24.61
|
| Rate for Payer: Cigna of CA PPO |
$28.46
|
| Rate for Payer: Adventist Health Commercial |
$7.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| 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 |
$28.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Senior |
$15.38
|
| Rate for Payer: Galaxy Health WC |
$32.69
|
| Rate for Payer: Global Benefits Group Commercial |
$23.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.92
|
| Rate for Payer: Multiplan Commercial |
$30.77
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$32.69
|
| 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 Commercial/Exchange |
$32.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.69
|
| Rate for Payer: Vantage Medical Group Senior |
$32.69
|
|
|
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 |
$32.69 |
| Rate for Payer: Adventist Health Commercial |
$7.69
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Senior |
$15.38
|
| Rate for Payer: Galaxy Health WC |
$32.69
|
| Rate for Payer: Global Benefits Group Commercial |
$23.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$30.77
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$32.69
|
|
|
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 |
$45.81 |
| Rate for Payer: Adventist Health Commercial |
$7.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| 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 |
$29.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.10
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| 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 Medi-Cal |
$33.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.64
|
| Rate for Payer: EPIC Health Plan Senior |
$15.64
|
| Rate for Payer: Galaxy Health WC |
$33.24
|
| Rate for Payer: Global Benefits Group Commercial |
$23.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.38
|
| Rate for Payer: Multiplan Commercial |
$31.29
|
| Rate for Payer: Networks By Design Commercial |
$25.42
|
| Rate for Payer: Prime Health Services Commercial |
$33.24
|
| 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 |
$19.55
|
| Rate for Payer: United Healthcare All Other HMO |
$19.55
|
| Rate for Payer: United Healthcare HMO Rider |
$19.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.24
|
| Rate for Payer: Vantage Medical Group Senior |
$33.24
|
|
|
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 |
$33.24 |
| Rate for Payer: Adventist Health Commercial |
$7.82
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.64
|
| Rate for Payer: EPIC Health Plan Senior |
$15.64
|
| Rate for Payer: Galaxy Health WC |
$33.24
|
| Rate for Payer: Global Benefits Group Commercial |
$23.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.39
|
| Rate for Payer: Multiplan Commercial |
$31.29
|
| Rate for Payer: Networks By Design Commercial |
$25.42
|
| Rate for Payer: Prime Health Services Commercial |
$33.24
|
|
|
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 |
$45.81 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| 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 |
$26.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.79
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Cash Price |
$15.98
|
| 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 Medi-Cal |
$30.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.18
|
| Rate for Payer: Global Benefits Group Commercial |
$21.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.86
|
| Rate for Payer: Multiplan Commercial |
$28.41
|
| Rate for Payer: Networks By Design Commercial |
$23.08
|
| Rate for Payer: Prime Health Services Commercial |
$30.18
|
| 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 |
$17.75
|
| Rate for Payer: United Healthcare All Other HMO |
$17.75
|
| Rate for Payer: United Healthcare HMO Rider |
$17.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.18
|
| Rate for Payer: Vantage Medical Group Senior |
$30.18
|
|
|
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 |
$30.18 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.18
|
| Rate for Payer: Global Benefits Group Commercial |
$21.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$28.41
|
| Rate for Payer: Networks By Design Commercial |
$23.08
|
| Rate for Payer: Prime Health Services Commercial |
$30.18
|
|
|
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 |
$32.62 |
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Senior |
$15.35
|
| Rate for Payer: Galaxy Health WC |
$32.62
|
| Rate for Payer: Global Benefits Group Commercial |
$23.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.21
|
| Rate for Payer: Multiplan Commercial |
$30.70
|
| Rate for Payer: Networks By Design Commercial |
$24.95
|
| Rate for Payer: Prime Health Services Commercial |
$32.62
|
|
|
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 |
$45.81 |
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| 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 |
$28.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.63
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| 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 Medi-Cal |
$32.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Senior |
$15.35
|
| Rate for Payer: Galaxy Health WC |
$32.62
|
| Rate for Payer: Global Benefits Group Commercial |
$23.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$30.70
|
| Rate for Payer: Networks By Design Commercial |
$24.95
|
| Rate for Payer: Prime Health Services Commercial |
$32.62
|
| 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 Commercial/Exchange |
$32.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.62
|
| Rate for Payer: Vantage Medical Group Senior |
$32.62
|
|
|
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 |
$45.81 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.71
|
| Rate for Payer: Vantage Medical Group Senior |
$37.71
|
| Rate for Payer: Adventist Health Commercial |
$8.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.81
|
| 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 |
$28.47
|
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Cash Price |
$19.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.05
|
| 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 Foundation Hospitals Commercial/Self Funded |
$28.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.17
|
| 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
|
|
|
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 |
$37.71 |
| Rate for Payer: Adventist Health Commercial |
$8.87
|
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.05
|
| 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 Foundation Hospitals Commercial/Self Funded |
$28.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.65
|
| 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
|
|
|
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: 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 |
$51.36
|
| Rate for Payer: Cash Price |
$36.01
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.22
|
| 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
|
| Rate for Payer: Vantage Medical Group Senior |
$68.03
|
|
|
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 |
$36.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.22
|
| 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 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 |
$4.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.35
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.20
|
| 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 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 |
$27.67 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.67
|
| 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 |
$6.74
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cash Price |
$4.73
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.35
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.20
|
| 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 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 |
$4.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.35
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.20
|
| 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 |
$27.67 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.67
|
| 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 |
$6.74
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cash Price |
$4.73
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.35
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.20
|
| 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 |
$27.67 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.67
|
| 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 |
$8.10
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cash Price |
$5.68
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.84
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| 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: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.84
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| 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 |
$45.81
|
| 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 |
$119.71
|
| Rate for Payer: Cash Price |
$83.95
|
| Rate for Payer: Cash Price |
$83.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.59
|
| 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 Foundation Hospitals Commercial/Self Funded |
$118.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.06
|
| 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 |
$83.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.59
|
| 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 Foundation Hospitals Commercial/Self Funded |
$118.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.06
|
| 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
|
|
