|
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 |
$35.20 |
| Rate for Payer: Adventist Health Commercial |
$7.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.75
|
| 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 Exchange |
$18.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.97
|
| Rate for Payer: Blue Shield of California Commercial |
$23.90
|
| Rate for Payer: Blue Shield of California EPN |
$15.60
|
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Central Health Plan Commercial |
$31.29
|
| Rate for Payer: Cigna of CA HMO |
$25.03
|
| Rate for Payer: Cigna of CA PPO |
$28.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.24
|
| 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: Health Management Network EPO/PPO |
$35.20
|
| Rate for Payer: InnovAge PACE Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.82
|
| 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 |
$29.33
|
| Rate for Payer: Networks By Design Commercial |
$25.42
|
| Rate for Payer: Prime Health Services Commercial |
$33.24
|
| Rate for Payer: Riverside University Health System MISP |
$15.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.55
|
| 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 |
$35.20 |
| Rate for Payer: Adventist Health Commercial |
$7.82
|
| Rate for Payer: Cash Price |
$21.51
|
| Rate for Payer: Central Health Plan Commercial |
$31.29
|
| 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: Health Management Network EPO/PPO |
$35.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.82
|
| Rate for Payer: Multiplan Commercial |
$29.33
|
| Rate for Payer: Networks By Design Commercial |
$25.42
|
| Rate for Payer: Prime Health Services Commercial |
$33.24
|
|
|
HC DRSNG MEPILEX BORDER 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 |
$31.96 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.57
|
| 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 Exchange |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.86
|
| Rate for Payer: Blue Shield of California Commercial |
$21.70
|
| Rate for Payer: Blue Shield of California EPN |
$14.17
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Central Health Plan Commercial |
$28.41
|
| Rate for Payer: Cigna of CA HMO |
$22.73
|
| Rate for Payer: Cigna of CA PPO |
$26.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.18
|
| 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: Health Management Network EPO/PPO |
$31.96
|
| Rate for Payer: InnovAge PACE Commercial |
$17.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.10
|
| 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 |
$26.63
|
| Rate for Payer: Networks By Design Commercial |
$23.08
|
| Rate for Payer: Prime Health Services Commercial |
$30.18
|
| Rate for Payer: Riverside University Health System MISP |
$14.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.75
|
| 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 |
$31.96 |
| Rate for Payer: Adventist Health Commercial |
$7.10
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Central Health Plan Commercial |
$28.41
|
| 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: Health Management Network EPO/PPO |
$31.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.10
|
| Rate for Payer: Multiplan Commercial |
$26.63
|
| Rate for Payer: Networks By Design Commercial |
$23.08
|
| Rate for Payer: Prime Health Services Commercial |
$30.18
|
|
|
HC DRSNG MEPILEX BORDER 6X6"
|
Facility
|
IP
|
$38.38
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$34.54 |
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$21.11
|
| Rate for Payer: Central Health Plan Commercial |
$30.70
|
| 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: Health Management Network EPO/PPO |
$34.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$28.79
|
| 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 |
$34.54 |
| Rate for Payer: Adventist Health Commercial |
$7.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.31
|
| 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 Exchange |
$18.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.54
|
| Rate for Payer: Blue Shield of California Commercial |
$23.45
|
| Rate for Payer: Blue Shield of California EPN |
$15.31
|
| Rate for Payer: Cash Price |
$21.11
|
| Rate for Payer: Central Health Plan Commercial |
$30.70
|
| Rate for Payer: Cigna of CA HMO |
$24.56
|
| Rate for Payer: Cigna of CA PPO |
$28.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.62
|
| 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: Health Management Network EPO/PPO |
$34.54
|
| Rate for Payer: InnovAge PACE Commercial |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| 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 |
$28.79
|
| Rate for Payer: Networks By Design Commercial |
$24.95
|
| Rate for Payer: Prime Health Services Commercial |
$32.62
|
| Rate for Payer: Riverside University Health System MISP |
$15.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.19
|
| Rate for Payer: United Healthcare All Other HMO |
$19.19
|
| Rate for Payer: United Healthcare HMO Rider |
$19.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.19
|
| Rate for Payer: Vantage Medical Group 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
|
IP
|
$44.36
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$39.92 |
| Rate for Payer: Adventist Health Commercial |
$8.87
|
| Rate for Payer: Cash Price |
$24.40
|
| Rate for Payer: Central Health Plan Commercial |
$35.49
|
| 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: Health Management Network EPO/PPO |
$39.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.87
|
| Rate for Payer: Multiplan Commercial |
$33.27
|
| Rate for Payer: Networks By Design Commercial |
$28.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.71
|
|
|
HC DRSNG MEPILEX BORDER 6X8"
|
Facility
|
OP
|
$44.36
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$39.92 |
| Rate for Payer: Adventist Health Commercial |
$8.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.94
|
| 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 Exchange |
$21.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.05
|
| Rate for Payer: Blue Shield of California Commercial |
$27.10
|
| Rate for Payer: Blue Shield of California EPN |
$17.70
|
| Rate for Payer: Cash Price |
$24.40
|
| Rate for Payer: Central Health Plan Commercial |
$35.49
|
| Rate for Payer: Cigna of CA HMO |
$28.39
|
| Rate for Payer: Cigna of CA PPO |
$32.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.71
|
| Rate for Payer: Dignity Health 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: Health Management Network EPO/PPO |
$39.92
|
| Rate for Payer: InnovAge PACE Commercial |
$22.18
|
| 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 |
$8.87
|
| 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 |
$33.27
|
| Rate for Payer: Networks By Design Commercial |
$28.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.71
|
| Rate for Payer: Riverside University Health System MISP |
$17.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.18
|
| Rate for Payer: United Healthcare All Other HMO |
$22.18
|
| Rate for Payer: United Healthcare HMO Rider |
$22.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.18
|
| Rate for Payer: Vantage Medical Group 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
|
OP
|
$79.87
|
|
| Hospital Charge Code |
901698343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$71.88 |
| Rate for Payer: Adventist Health Commercial |
$15.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.91
|
| Rate for Payer: Blue Shield of California Commercial |
$48.80
|
| Rate for Payer: Blue Shield of California EPN |
$31.87
|
| Rate for Payer: Cash Price |
$43.93
|
| Rate for Payer: Central Health Plan Commercial |
$63.90
|
| Rate for Payer: Cigna of CA HMO |
$51.12
|
| Rate for Payer: Cigna of CA PPO |
$59.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.95
|
| Rate for Payer: EPIC Health Plan Senior |
$31.95
|
| Rate for Payer: Galaxy Health WC |
$67.89
|
| Rate for Payer: Global Benefits Group Commercial |
$47.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.88
|
| Rate for Payer: InnovAge PACE Commercial |
$39.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.91
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Networks By Design Commercial |
$51.92
|
| Rate for Payer: Prime Health Services Commercial |
$67.89
|
| Rate for Payer: Riverside University Health System MISP |
$31.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.94
|
| Rate for Payer: United Healthcare All Other HMO |
$39.94
|
| Rate for Payer: United Healthcare HMO Rider |
$39.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.89
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC DRSNG MEPILEX BRDR 8.7X9.1"
|
Facility
|
IP
|
$79.87
|
|
| Hospital Charge Code |
901698343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$71.88 |
| Rate for Payer: Adventist Health Commercial |
$15.97
|
| Rate for Payer: Cash Price |
$43.93
|
| Rate for Payer: Central Health Plan Commercial |
$63.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.95
|
| Rate for Payer: EPIC Health Plan Senior |
$31.95
|
| Rate for Payer: Galaxy Health WC |
$67.89
|
| Rate for Payer: Global Benefits Group Commercial |
$47.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.97
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Networks By Design Commercial |
$51.92
|
| Rate for Payer: Prime Health Services Commercial |
$67.89
|
|
|
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 |
$9.45 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.38
|
| 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 Exchange |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.17
|
| Rate for Payer: Blue Shield of California Commercial |
$6.42
|
| Rate for Payer: Blue Shield of California EPN |
$4.19
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Central Health Plan Commercial |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.93
|
| 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: Health Management Network EPO/PPO |
$9.45
|
| Rate for Payer: InnovAge PACE Commercial |
$5.25
|
| 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 |
$2.10
|
| 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 |
$7.88
|
| Rate for Payer: Networks By Design Commercial |
$6.83
|
| Rate for Payer: Prime Health Services Commercial |
$8.93
|
| Rate for Payer: Riverside University Health System MISP |
$4.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Vantage Medical Group 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 |
$9.45 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Central Health Plan Commercial |
$8.40
|
| 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: Health Management Network EPO/PPO |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.88
|
| Rate for Payer: Networks By Design Commercial |
$6.83
|
| 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 |
$9.45 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.38
|
| 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 Exchange |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.17
|
| Rate for Payer: Blue Shield of California Commercial |
$6.42
|
| Rate for Payer: Blue Shield of California EPN |
$4.19
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Central Health Plan Commercial |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.93
|
| 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: Health Management Network EPO/PPO |
$9.45
|
| Rate for Payer: InnovAge PACE Commercial |
$5.25
|
| 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 |
$2.10
|
| 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 |
$7.88
|
| Rate for Payer: Networks By Design Commercial |
$6.83
|
| Rate for Payer: Prime Health Services Commercial |
$8.93
|
| Rate for Payer: Riverside University Health System MISP |
$4.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Vantage Medical Group 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 |
$9.45 |
| Rate for Payer: Adventist Health Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$5.78
|
| Rate for Payer: Central Health Plan Commercial |
$8.40
|
| 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: Health Management Network EPO/PPO |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.88
|
| Rate for Payer: Networks By Design Commercial |
$6.83
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$11.37 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.67
|
| 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 Exchange |
$6.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.42
|
| Rate for Payer: Blue Shield of California Commercial |
$7.72
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Central Health Plan Commercial |
$10.10
|
| Rate for Payer: Cigna of CA HMO |
$8.08
|
| Rate for Payer: Cigna of CA PPO |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.74
|
| Rate for Payer: Dignity Health 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: Health Management Network EPO/PPO |
$11.37
|
| Rate for Payer: InnovAge PACE Commercial |
$6.32
|
| 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 |
$2.53
|
| 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 |
$9.47
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
| Rate for Payer: Riverside University Health System MISP |
$5.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.32
|
| Rate for Payer: United Healthcare All Other HMO |
$6.32
|
| Rate for Payer: United Healthcare HMO Rider |
$6.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.32
|
| Rate for Payer: Vantage Medical Group 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 |
$11.37 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Central Health Plan Commercial |
$10.10
|
| 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: Health Management Network EPO/PPO |
$11.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$9.47
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X10"
|
Facility
|
IP
|
$186.13
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.23 |
| Max. Negotiated Rate |
$167.52 |
| Rate for Payer: Adventist Health Commercial |
$37.23
|
| Rate for Payer: Cash Price |
$102.37
|
| Rate for Payer: Central Health Plan Commercial |
$148.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.45
|
| Rate for Payer: EPIC Health Plan Senior |
$74.45
|
| Rate for Payer: Galaxy Health WC |
$158.21
|
| Rate for Payer: Global Benefits Group Commercial |
$111.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.23
|
| Rate for Payer: Multiplan Commercial |
$139.60
|
| Rate for Payer: Networks By Design Commercial |
$120.98
|
| Rate for Payer: Prime Health Services Commercial |
$158.21
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X10"
|
Facility
|
OP
|
$186.13
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.23 |
| Max. Negotiated Rate |
$167.52 |
| Rate for Payer: Adventist Health Commercial |
$37.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.31
|
| Rate for Payer: Blue Shield of California Commercial |
$113.73
|
| Rate for Payer: Blue Shield of California EPN |
$74.27
|
| Rate for Payer: Cash Price |
$102.37
|
| Rate for Payer: Central Health Plan Commercial |
$148.90
|
| Rate for Payer: Cigna of CA HMO |
$119.12
|
| Rate for Payer: Cigna of CA PPO |
$137.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.45
|
| Rate for Payer: EPIC Health Plan Senior |
$74.45
|
| Rate for Payer: Galaxy Health WC |
$158.21
|
| Rate for Payer: Global Benefits Group Commercial |
$111.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.52
|
| Rate for Payer: InnovAge PACE Commercial |
$93.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130.29
|
| Rate for Payer: Multiplan Commercial |
$139.60
|
| Rate for Payer: Networks By Design Commercial |
$120.98
|
| Rate for Payer: Prime Health Services Commercial |
$158.21
|
| Rate for Payer: Riverside University Health System MISP |
$74.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.06
|
| Rate for Payer: United Healthcare All Other HMO |
$93.06
|
| Rate for Payer: United Healthcare HMO Rider |
$93.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.21
|
| Rate for Payer: Vantage Medical Group Senior |
$158.21
|
|
|
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 |
$202.29 |
| Rate for Payer: Adventist Health Commercial |
$44.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.50
|
| 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 Exchange |
$108.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.01
|
| Rate for Payer: Blue Shield of California Commercial |
$137.33
|
| Rate for Payer: Blue Shield of California EPN |
$89.68
|
| Rate for Payer: Cash Price |
$123.62
|
| Rate for Payer: Central Health Plan Commercial |
$179.82
|
| 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: Health Management Network EPO/PPO |
$202.29
|
| Rate for Payer: InnovAge PACE Commercial |
$112.39
|
| 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 |
$44.95
|
| 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 |
$168.58
|
| Rate for Payer: Networks By Design Commercial |
$146.10
|
| Rate for Payer: Prime Health Services Commercial |
$191.05
|
| Rate for Payer: Riverside University Health System MISP |
$89.91
|
| 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 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 |
$202.29 |
| Rate for Payer: Adventist Health Commercial |
$44.95
|
| Rate for Payer: Cash Price |
$123.62
|
| Rate for Payer: Central Health Plan Commercial |
$179.82
|
| 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: Health Management Network EPO/PPO |
$202.29
|
| 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 |
$44.95
|
| Rate for Payer: Multiplan Commercial |
$168.58
|
| Rate for Payer: Networks By Design Commercial |
$146.10
|
| Rate for Payer: Prime Health Services Commercial |
$191.05
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X14"
|
Facility
|
OP
|
$246.19
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.24 |
| Max. Negotiated Rate |
$221.57 |
| Rate for Payer: Adventist Health Commercial |
$49.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.59
|
| Rate for Payer: Blue Shield of California Commercial |
$150.42
|
| Rate for Payer: Blue Shield of California EPN |
$98.23
|
| Rate for Payer: Cash Price |
$135.40
|
| Rate for Payer: Central Health Plan Commercial |
$196.95
|
| Rate for Payer: Cigna of CA HMO |
$157.56
|
| Rate for Payer: Cigna of CA PPO |
$182.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.48
|
| Rate for Payer: EPIC Health Plan Senior |
$98.48
|
| Rate for Payer: Galaxy Health WC |
$209.26
|
| Rate for Payer: Global Benefits Group Commercial |
$147.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.57
|
| Rate for Payer: InnovAge PACE Commercial |
$123.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.33
|
| Rate for Payer: Multiplan Commercial |
$184.64
|
| Rate for Payer: Networks By Design Commercial |
$160.02
|
| Rate for Payer: Prime Health Services Commercial |
$209.26
|
| Rate for Payer: Riverside University Health System MISP |
$98.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.09
|
| Rate for Payer: United Healthcare All Other HMO |
$123.09
|
| Rate for Payer: United Healthcare HMO Rider |
$123.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.26
|
| Rate for Payer: Vantage Medical Group Senior |
$209.26
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X14"
|
Facility
|
IP
|
$246.19
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.24 |
| Max. Negotiated Rate |
$221.57 |
| Rate for Payer: Adventist Health Commercial |
$49.24
|
| Rate for Payer: Cash Price |
$135.40
|
| Rate for Payer: Central Health Plan Commercial |
$196.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.48
|
| Rate for Payer: EPIC Health Plan Senior |
$98.48
|
| Rate for Payer: Galaxy Health WC |
$209.26
|
| Rate for Payer: Global Benefits Group Commercial |
$147.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.24
|
| Rate for Payer: Multiplan Commercial |
$184.64
|
| Rate for Payer: Networks By Design Commercial |
$160.02
|
| Rate for Payer: Prime Health Services Commercial |
$209.26
|
|
|
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: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| 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: 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: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| 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: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.31
|
| 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 Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.27
|
| Rate for Payer: Blue Shield of California Commercial |
$92.87
|
| Rate for Payer: Blue Shield of California EPN |
$60.65
|
| Rate for Payer: Cash Price |
$83.60
|
| 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 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: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: InnovAge PACE Commercial |
$76.00
|
| 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 |
$30.40
|
| 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 |
$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 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 4X8"
|
Facility
|
IP
|
$172.83
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$155.55 |
| Rate for Payer: Adventist Health Commercial |
$34.57
|
| Rate for Payer: Cash Price |
$95.06
|
| Rate for Payer: Central Health Plan Commercial |
$138.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.13
|
| Rate for Payer: EPIC Health Plan Senior |
$69.13
|
| Rate for Payer: Galaxy Health WC |
$146.91
|
| Rate for Payer: Global Benefits Group Commercial |
$103.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.57
|
| Rate for Payer: Multiplan Commercial |
$129.62
|
| Rate for Payer: Networks By Design Commercial |
$112.34
|
| Rate for Payer: Prime Health Services Commercial |
$146.91
|
|
