|
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 |
$4.73
|
| 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 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 |
$4.73
|
| Rate for Payer: Central Health Plan Commercial |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.93
|
| 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 |
$4.73
|
| 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 |
$4.73
|
| Rate for Payer: Central Health Plan Commercial |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.93
|
| 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 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 |
$5.68
|
| Rate for Payer: Central Health Plan Commercial |
$10.10
|
| Rate for Payer: Cigna of CA HMO |
$8.08
|
| Rate for Payer: Cigna of CA PPO |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.74
|
| Rate for Payer: Dignity Health 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 |
$5.68
|
| 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 |
$83.76
|
| 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 |
$83.76
|
| 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 |
$101.15
|
| 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 |
$101.15
|
| 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
|
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 |
$110.79
|
| 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 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 |
$110.79
|
| 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 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 |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health 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 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 |
$68.40
|
| 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 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 |
$77.77
|
| 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
|
|
|
HC DRSNG MEPILEX POST-OP AG 4X8"
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$104.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.50
|
| Rate for Payer: Blue Shield of California Commercial |
$105.60
|
| Rate for Payer: Blue Shield of California EPN |
$68.96
|
| Rate for Payer: Cash Price |
$77.77
|
| Rate for Payer: Central Health Plan Commercial |
$138.26
|
| Rate for Payer: Cigna of CA HMO |
$110.61
|
| Rate for Payer: Cigna of CA PPO |
$127.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$146.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.91
|
| 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: InnovAge PACE Commercial |
$86.42
|
| 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: Molina Healthcare of CA Medi-Cal |
$120.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120.98
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$69.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.42
|
| Rate for Payer: United Healthcare All Other HMO |
$86.42
|
| Rate for Payer: United Healthcare HMO Rider |
$86.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$146.91
|
| Rate for Payer: Vantage Medical Group Senior |
$146.91
|
|
|
HC DRSNG MEPILEX SACRAL 7X7
|
Facility
|
OP
|
$47.48
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$9.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.89
|
| Rate for Payer: Blue Shield of California Commercial |
$29.01
|
| Rate for Payer: Blue Shield of California EPN |
$18.94
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Central Health Plan Commercial |
$37.98
|
| Rate for Payer: Cigna of CA HMO |
$30.39
|
| Rate for Payer: Cigna of CA PPO |
$35.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: EPIC Health Plan Senior |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.73
|
| Rate for Payer: InnovAge PACE Commercial |
$23.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.24
|
| Rate for Payer: Multiplan Commercial |
$35.61
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
| Rate for Payer: Riverside University Health System MISP |
$18.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.74
|
| Rate for Payer: United Healthcare All Other HMO |
$23.74
|
| Rate for Payer: United Healthcare HMO Rider |
$23.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.36
|
| Rate for Payer: Vantage Medical Group Senior |
$40.36
|
|
|
HC DRSNG MEPILEX SACRAL 7X7
|
Facility
|
IP
|
$47.48
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$9.50
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Central Health Plan Commercial |
$37.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.99
|
| Rate for Payer: EPIC Health Plan Senior |
$18.99
|
| Rate for Payer: Galaxy Health WC |
$40.36
|
| Rate for Payer: Global Benefits Group Commercial |
$28.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$35.61
|
| Rate for Payer: Networks By Design Commercial |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$40.36
|
|
|
HC DRSNG MEPILEX SACRAL 9X9
|
Facility
|
OP
|
$74.54
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$67.09 |
| Rate for Payer: Adventist Health Commercial |
$14.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.78
|
| Rate for Payer: Blue Shield of California Commercial |
$45.54
|
| Rate for Payer: Blue Shield of California EPN |
$29.74
|
| Rate for Payer: Cash Price |
$33.54
|
| Rate for Payer: Central Health Plan Commercial |
$59.63
|
| Rate for Payer: Cigna of CA HMO |
$47.71
|
| Rate for Payer: Cigna of CA PPO |
$55.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.82
|
| Rate for Payer: EPIC Health Plan Senior |
$29.82
|
| Rate for Payer: Galaxy Health WC |
$63.36
|
| Rate for Payer: Global Benefits Group Commercial |
$44.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.09
|
| Rate for Payer: InnovAge PACE Commercial |
$37.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.18
|
| Rate for Payer: Multiplan Commercial |
$55.91
|
| Rate for Payer: Networks By Design Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Commercial |
$63.36
|
| Rate for Payer: Riverside University Health System MISP |
$29.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.27
|
| Rate for Payer: United Healthcare All Other HMO |
$37.27
|
| Rate for Payer: United Healthcare HMO Rider |
$37.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.36
|
| Rate for Payer: Vantage Medical Group Senior |
$63.36
|
|
|
HC DRSNG MEPILEX SACRAL 9X9
|
Facility
|
IP
|
$74.54
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901698227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$67.09 |
| Rate for Payer: Adventist Health Commercial |
$14.91
|
| Rate for Payer: Cash Price |
$33.54
|
| Rate for Payer: Central Health Plan Commercial |
$59.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.82
|
| Rate for Payer: EPIC Health Plan Senior |
$29.82
|
| Rate for Payer: Galaxy Health WC |
$63.36
|
| Rate for Payer: Global Benefits Group Commercial |
$44.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.91
|
| Rate for Payer: Multiplan Commercial |
$55.91
|
| Rate for Payer: Networks By Design Commercial |
$48.45
|
| Rate for Payer: Prime Health Services Commercial |
$63.36
|
|
|
HC DRSNG MEPILEX SACRUM 9.2X9.2
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901602024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health 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: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| 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 |
$16.40
|
| 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 |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRSNG MEPILEX SACRUM 9.2X9.2
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901602024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: 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: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC DRSNG MEPILEX TRANSFER AG 8X8
|
Facility
|
OP
|
$256.69
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901607630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.34 |
| Max. Negotiated Rate |
$231.02 |
| Rate for Payer: Adventist Health Commercial |
$51.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$218.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$141.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.75
|
| Rate for Payer: Blue Shield of California Commercial |
$156.84
|
| Rate for Payer: Blue Shield of California EPN |
$102.42
|
| Rate for Payer: Cash Price |
$115.51
|
| Rate for Payer: Central Health Plan Commercial |
$205.35
|
| Rate for Payer: Cigna of CA HMO |
$164.28
|
| Rate for Payer: Cigna of CA PPO |
$189.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$218.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$218.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.68
|
| Rate for Payer: EPIC Health Plan Senior |
$102.68
|
| Rate for Payer: Galaxy Health WC |
$218.19
|
| Rate for Payer: Global Benefits Group Commercial |
$154.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$231.02
|
| Rate for Payer: InnovAge PACE Commercial |
$128.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$171.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$179.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$179.68
|
| Rate for Payer: Multiplan Commercial |
$192.52
|
| Rate for Payer: Networks By Design Commercial |
$166.85
|
| Rate for Payer: Prime Health Services Commercial |
$218.19
|
| Rate for Payer: Riverside University Health System MISP |
$102.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$154.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$154.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.34
|
| Rate for Payer: United Healthcare All Other HMO |
$128.34
|
| Rate for Payer: United Healthcare HMO Rider |
$128.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$218.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.19
|
| Rate for Payer: Vantage Medical Group Senior |
$218.19
|
|
|
HC DRSNG MEPILEX TRANSFER AG 8X8
|
Facility
|
IP
|
$256.69
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901607630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.34 |
| Max. Negotiated Rate |
$231.02 |
| Rate for Payer: Adventist Health Commercial |
$51.34
|
| Rate for Payer: Cash Price |
$115.51
|
| Rate for Payer: Central Health Plan Commercial |
$205.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.68
|
| Rate for Payer: EPIC Health Plan Senior |
$102.68
|
| Rate for Payer: Galaxy Health WC |
$218.19
|
| Rate for Payer: Global Benefits Group Commercial |
$154.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$231.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$171.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.34
|
| Rate for Payer: Multiplan Commercial |
$192.52
|
| Rate for Payer: Networks By Design Commercial |
$166.85
|
| Rate for Payer: Prime Health Services Commercial |
$218.19
|
|
|
HC DRSNG MEPITEL 1 NON-ADH 4X7"
|
Facility
|
OP
|
$61.99
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$55.79 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.41
|
| Rate for Payer: Blue Shield of California Commercial |
$37.88
|
| Rate for Payer: Blue Shield of California EPN |
$24.73
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.59
|
| Rate for Payer: Cigna of CA HMO |
$39.67
|
| Rate for Payer: Cigna of CA PPO |
$45.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.69
|
| Rate for Payer: Global Benefits Group Commercial |
$37.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.79
|
| Rate for Payer: InnovAge PACE Commercial |
$31.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.39
|
| Rate for Payer: Multiplan Commercial |
$46.49
|
| Rate for Payer: Networks By Design Commercial |
$40.29
|
| Rate for Payer: Prime Health Services Commercial |
$52.69
|
| Rate for Payer: Riverside University Health System MISP |
$24.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.00
|
| Rate for Payer: United Healthcare All Other HMO |
$31.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.69
|
| Rate for Payer: Vantage Medical Group Senior |
$52.69
|
|
