|
HC BNDG COHESIVE 2"X5YD TAN NS
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698394
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
|
|
HC BNDG COHESIVE 2"X5YD TAN NS
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698394
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3.90
|
|
|
HC BNDG COHESIVE 2"X5YD TAN STERL
|
Facility
|
IP
|
$5.33
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.26
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
|
|
HC BNDG COHESIVE 2"X5YD TAN STERL
|
Facility
|
OP
|
$5.33
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.27
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna of CA HMO |
$3.41
|
| Rate for Payer: Cigna of CA PPO |
$3.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.73
|
| Rate for Payer: Multiplan Commercial |
$4.26
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.67
|
| Rate for Payer: United Healthcare All Other HMO |
$2.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4.53
|
|
|
HC BNDG COHESIVE 3" STERILE
|
Facility
|
OP
|
$8.86
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Adventist Health Commercial |
$1.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.44
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cigna of CA HMO |
$5.67
|
| Rate for Payer: Cigna of CA PPO |
$6.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.54
|
| Rate for Payer: EPIC Health Plan Senior |
$3.54
|
| Rate for Payer: Galaxy Health WC |
$7.53
|
| Rate for Payer: Global Benefits Group Commercial |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$7.09
|
| Rate for Payer: Networks By Design Commercial |
$5.76
|
| Rate for Payer: Prime Health Services Commercial |
$7.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Other HMO |
$4.43
|
| Rate for Payer: United Healthcare HMO Rider |
$4.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.53
|
| Rate for Payer: Vantage Medical Group Senior |
$7.53
|
|
|
HC BNDG COHESIVE 3" STERILE
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901607573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$13.25
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
HC BNDG COHESIVE 3" STERILE
|
Facility
|
OP
|
$16.56
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901607573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.17
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$13.25
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
HC BNDG COHESIVE 3" STERILE
|
Facility
|
IP
|
$8.86
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Adventist Health Commercial |
$1.77
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.54
|
| Rate for Payer: EPIC Health Plan Senior |
$3.54
|
| Rate for Payer: Galaxy Health WC |
$7.53
|
| Rate for Payer: Global Benefits Group Commercial |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.13
|
| Rate for Payer: Multiplan Commercial |
$7.09
|
| Rate for Payer: Networks By Design Commercial |
$5.76
|
| Rate for Payer: Prime Health Services Commercial |
$7.53
|
|
|
HC BNDG COHESIVE 3"X5YD COLOR NS
|
Facility
|
OP
|
$7.46
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.58
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$4.77
|
| Rate for Payer: Cigna of CA PPO |
$5.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$6.34
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$5.97
|
| Rate for Payer: Networks By Design Commercial |
$4.85
|
| Rate for Payer: Prime Health Services Commercial |
$6.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.34
|
| Rate for Payer: Vantage Medical Group Senior |
$6.34
|
|
|
HC BNDG COHESIVE 3"X5YD COLOR NS
|
Facility
|
IP
|
$7.46
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$6.34
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$5.97
|
| Rate for Payer: Networks By Design Commercial |
$4.85
|
| Rate for Payer: Prime Health Services Commercial |
$6.34
|
|
|
HC BNDG COHESIVE 3" X 5YD TAN
|
Facility
|
IP
|
$7.30
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901607545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.21 |
| Rate for Payer: Adventist Health Commercial |
$1.46
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Senior |
$2.92
|
| Rate for Payer: Galaxy Health WC |
$6.21
|
| Rate for Payer: Global Benefits Group Commercial |
$4.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$4.75
|
| Rate for Payer: Prime Health Services Commercial |
$6.21
|
|
|
HC BNDG COHESIVE 3" X 5YD TAN
|
Facility
|
OP
|
$7.30
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901607545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.21 |
| Rate for Payer: Adventist Health Commercial |
$1.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.48
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cigna of CA HMO |
$4.67
|
| Rate for Payer: Cigna of CA PPO |
$5.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Senior |
$2.92
|
| Rate for Payer: Galaxy Health WC |
$6.21
|
| Rate for Payer: Global Benefits Group Commercial |
$4.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.11
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$4.75
|
| Rate for Payer: Prime Health Services Commercial |
$6.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.65
|
| Rate for Payer: United Healthcare All Other HMO |
$3.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.21
|
| Rate for Payer: Vantage Medical Group Senior |
$6.21
|
|
|
HC BNDG COHESIVE 3"X5YD TAN NS
|
Facility
|
OP
|
$7.22
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698396
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.43
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna of CA HMO |
$4.62
|
| Rate for Payer: Cigna of CA PPO |
$5.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.89
|
| Rate for Payer: EPIC Health Plan Senior |
$2.89
|
| Rate for Payer: Galaxy Health WC |
$6.14
|
| Rate for Payer: Global Benefits Group Commercial |
$4.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$5.78
|
| Rate for Payer: Networks By Design Commercial |
$4.69
|
| Rate for Payer: Prime Health Services Commercial |
$6.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.61
|
| Rate for Payer: United Healthcare All Other HMO |
$3.61
|
| Rate for Payer: United Healthcare HMO Rider |
$3.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.14
|
| Rate for Payer: Vantage Medical Group Senior |
$6.14
|
|
|
HC BNDG COHESIVE 3"X5YD TAN NS
|
Facility
|
IP
|
$7.22
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698396
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: Adventist Health Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.89
|
| Rate for Payer: EPIC Health Plan Senior |
$2.89
|
| Rate for Payer: Galaxy Health WC |
$6.14
|
| Rate for Payer: Global Benefits Group Commercial |
$4.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$5.78
|
| Rate for Payer: Networks By Design Commercial |
$4.69
|
| Rate for Payer: Prime Health Services Commercial |
$6.14
|
|
|
HC BNDG COHESIVE 3" X 5YR COLORED
|
Facility
|
OP
|
$7.46
|
|
| Hospital Charge Code |
901698148
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.58
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cigna of CA HMO |
$4.77
|
| Rate for Payer: Cigna of CA PPO |
$5.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$6.34
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$5.97
|
| Rate for Payer: Networks By Design Commercial |
$4.85
|
| Rate for Payer: Prime Health Services Commercial |
$6.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.34
|
| Rate for Payer: Vantage Medical Group Senior |
$6.34
|
|
|
HC BNDG COHESIVE 3" X 5YR COLORED
|
Facility
|
IP
|
$7.46
|
|
| Hospital Charge Code |
901698148
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$6.34
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$5.97
|
| Rate for Payer: Networks By Design Commercial |
$4.85
|
| Rate for Payer: Prime Health Services Commercial |
$6.34
|
|
|
HC BNDG COHESIVE 4" STERILE
|
Facility
|
OP
|
$21.16
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901607574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.99
|
| Rate for Payer: Cash Price |
$9.52
|
| Rate for Payer: Cigna of CA HMO |
$13.54
|
| Rate for Payer: Cigna of CA PPO |
$15.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.81
|
| Rate for Payer: Multiplan Commercial |
$16.93
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.99
|
| Rate for Payer: Vantage Medical Group Senior |
$17.99
|
|
|
HC BNDG COHESIVE 4" STERILE
|
Facility
|
IP
|
$21.16
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901607574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$9.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.08
|
| Rate for Payer: Multiplan Commercial |
$16.93
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
|
|
HC BNDG COHESIVE 4" TAN NON STERL
|
Facility
|
IP
|
$9.51
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698399
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$7.61
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
|
|
HC BNDG COHESIVE 4" TAN NON STERL
|
Facility
|
OP
|
$9.51
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698399
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.84
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$7.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.66
|
| Rate for Payer: Multiplan Commercial |
$7.61
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO |
$4.75
|
| Rate for Payer: United Healthcare HMO Rider |
$4.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC BNDG COHESIVE 4" TAN STERILE
|
Facility
|
OP
|
$12.22
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Adventist Health Commercial |
$2.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.50
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna of CA HMO |
$7.82
|
| Rate for Payer: Cigna of CA PPO |
$9.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.89
|
| Rate for Payer: EPIC Health Plan Senior |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$10.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.55
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: Networks By Design Commercial |
$7.94
|
| Rate for Payer: Prime Health Services Commercial |
$10.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.11
|
| Rate for Payer: United Healthcare All Other HMO |
$6.11
|
| Rate for Payer: United Healthcare HMO Rider |
$6.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.39
|
| Rate for Payer: Vantage Medical Group Senior |
$10.39
|
|
|
HC BNDG COHESIVE 4" TAN STERILE
|
Facility
|
IP
|
$12.22
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$10.39 |
| Rate for Payer: Adventist Health Commercial |
$2.44
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.89
|
| Rate for Payer: EPIC Health Plan Senior |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$10.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: Networks By Design Commercial |
$7.94
|
| Rate for Payer: Prime Health Services Commercial |
$10.39
|
|
|
HC BNDG COHESIVE 4" X 5YD TAN
|
Facility
|
IP
|
$10.41
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901607544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: EPIC Health Plan Senior |
$4.16
|
| Rate for Payer: Galaxy Health WC |
$8.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Multiplan Commercial |
$8.33
|
| Rate for Payer: Networks By Design Commercial |
$6.77
|
| Rate for Payer: Prime Health Services Commercial |
$8.85
|
|
|
HC BNDG COHESIVE 4" X 5YD TAN
|
Facility
|
OP
|
$10.41
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901607544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: Adventist Health Commercial |
$2.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.39
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: EPIC Health Plan Senior |
$4.16
|
| Rate for Payer: Galaxy Health WC |
$8.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.29
|
| Rate for Payer: Multiplan Commercial |
$8.33
|
| Rate for Payer: Networks By Design Commercial |
$6.77
|
| Rate for Payer: Prime Health Services Commercial |
$8.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.21
|
| Rate for Payer: United Healthcare All Other HMO |
$5.21
|
| Rate for Payer: United Healthcare HMO Rider |
$5.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8.85
|
|
|
HC BNDG COHESIVE 6" STERILE
|
Facility
|
IP
|
$25.91
|
|
|
Service Code
|
CPT A6455
|
| Hospital Charge Code |
901607575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$22.02 |
| Rate for Payer: Adventist Health Commercial |
$5.18
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: EPIC Health Plan Senior |
$10.36
|
| Rate for Payer: Galaxy Health WC |
$22.02
|
| Rate for Payer: Global Benefits Group Commercial |
$15.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.22
|
| Rate for Payer: Multiplan Commercial |
$20.73
|
| Rate for Payer: Networks By Design Commercial |
$16.84
|
| Rate for Payer: Prime Health Services Commercial |
$22.02
|
|
