|
HC BNDG PLASTER 3"
|
Facility
|
OP
|
$6.15
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605893
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.78
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cigna of CA HMO |
$3.94
|
| Rate for Payer: Cigna of CA PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Vantage Medical Group Senior |
$5.23
|
|
|
HC BNDG PLASTER 3"
|
Facility
|
IP
|
$6.15
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605893
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
|
|
HC BNDG PLASTER 4"
|
Facility
|
OP
|
$10.66
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605894
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Adventist Health Commercial |
$2.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.55
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$6.82
|
| Rate for Payer: Cigna of CA PPO |
$7.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4.26
|
| Rate for Payer: Galaxy Health WC |
$9.06
|
| Rate for Payer: Global Benefits Group Commercial |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$8.53
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$9.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.06
|
| Rate for Payer: Vantage Medical Group Senior |
$9.06
|
|
|
HC BNDG PLASTER 4"
|
Facility
|
IP
|
$10.66
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605894
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Adventist Health Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4.26
|
| Rate for Payer: Galaxy Health WC |
$9.06
|
| Rate for Payer: Global Benefits Group Commercial |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$8.53
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$9.06
|
|
|
HC BNDG PLASTER 4IN EXTRA FAST
|
Facility
|
OP
|
$12.63
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901698873
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.76
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cigna of CA HMO |
$8.08
|
| Rate for Payer: Cigna of CA PPO |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.84
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.32
|
| Rate for Payer: United Healthcare All Other HMO |
$6.32
|
| Rate for Payer: United Healthcare HMO Rider |
$6.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC BNDG PLASTER 4IN EXTRA FAST
|
Facility
|
IP
|
$12.63
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901698873
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
|
|
HC BNDG PLASTER 4IN FAST SETTING
|
Facility
|
IP
|
$12.63
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901698872
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
|
|
HC BNDG PLASTER 4IN FAST SETTING
|
Facility
|
OP
|
$12.63
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901698872
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.76
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cigna of CA HMO |
$8.08
|
| Rate for Payer: Cigna of CA PPO |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.84
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.32
|
| Rate for Payer: United Healthcare All Other HMO |
$6.32
|
| Rate for Payer: United Healthcare HMO Rider |
$6.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC BNDG PLASTER 5"
|
Facility
|
OP
|
$13.28
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605895
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.16
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Cigna of CA HMO |
$8.50
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.29
|
| Rate for Payer: Vantage Medical Group Senior |
$11.29
|
|
|
HC BNDG PLASTER 5"
|
Facility
|
IP
|
$13.28
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605895
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
|
|
HC BNDG PLASTER 6"
|
Facility
|
IP
|
$15.25
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605198
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Senior |
$6.10
|
| Rate for Payer: Galaxy Health WC |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$9.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.66
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: Networks By Design Commercial |
$9.91
|
| Rate for Payer: Prime Health Services Commercial |
$12.96
|
|
|
HC BNDG PLASTER 6"
|
Facility
|
OP
|
$15.25
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605198
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.37
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cigna of CA HMO |
$9.76
|
| Rate for Payer: Cigna of CA PPO |
$11.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.10
|
| Rate for Payer: EPIC Health Plan Senior |
$6.10
|
| Rate for Payer: Galaxy Health WC |
$12.96
|
| Rate for Payer: Global Benefits Group Commercial |
$9.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$12.20
|
| Rate for Payer: Networks By Design Commercial |
$9.91
|
| Rate for Payer: Prime Health Services Commercial |
$12.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.62
|
| Rate for Payer: United Healthcare All Other HMO |
$7.62
|
| Rate for Payer: United Healthcare HMO Rider |
$7.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.96
|
| Rate for Payer: Vantage Medical Group Senior |
$12.96
|
|
|
HC BNDG SELF ADHESIVE 1X5YD LF NS
|
Facility
|
OP
|
$3.12
|
|
| Hospital Charge Code |
901698112
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.92
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2.65
|
|
|
HC BNDG SELF ADHESIVE 1X5YD LF NS
|
Facility
|
IP
|
$3.12
|
|
| Hospital Charge Code |
901698112
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
|
|
HC BNDG SELF ADHESIVE 2" CP
|
Facility
|
IP
|
$7.05
|
|
| Hospital Charge Code |
901698113
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: EPIC Health Plan Senior |
$2.82
|
| Rate for Payer: Galaxy Health WC |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$5.64
|
| Rate for Payer: Networks By Design Commercial |
$4.58
|
| Rate for Payer: Prime Health Services Commercial |
$5.99
|
|
|
HC BNDG SELF ADHESIVE 2" CP
|
Facility
|
OP
|
$7.05
|
|
| Hospital Charge Code |
901698113
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Adventist Health Commercial |
$1.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.33
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cigna of CA HMO |
$4.51
|
| Rate for Payer: Cigna of CA PPO |
$5.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.82
|
| Rate for Payer: EPIC Health Plan Senior |
$2.82
|
| Rate for Payer: Galaxy Health WC |
$5.99
|
| Rate for Payer: Global Benefits Group Commercial |
$4.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.93
|
| Rate for Payer: Multiplan Commercial |
$5.64
|
| Rate for Payer: Networks By Design Commercial |
$4.58
|
| Rate for Payer: Prime Health Services Commercial |
$5.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.52
|
| Rate for Payer: United Healthcare All Other HMO |
$3.52
|
| Rate for Payer: United Healthcare HMO Rider |
$3.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.99
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC BNDG SELF ADHESIVE 3" CP
|
Facility
|
IP
|
$6.40
|
|
| Hospital Charge Code |
901698114
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.12
|
| Rate for Payer: Networks By Design Commercial |
$4.16
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
|
|
HC BNDG SELF ADHESIVE 3" CP
|
Facility
|
OP
|
$6.40
|
|
| Hospital Charge Code |
901698114
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Adventist Health Commercial |
$1.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.93
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cigna of CA HMO |
$4.10
|
| Rate for Payer: Cigna of CA PPO |
$4.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Senior |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$5.12
|
| Rate for Payer: Networks By Design Commercial |
$4.16
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$5.44
|
|
|
HC BNDG SELF ADHESIVE 3" STERILE
|
Facility
|
IP
|
$15.01
|
|
| Hospital Charge Code |
901698115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.76
|
| Rate for Payer: Global Benefits Group Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.01
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
|
|
HC BNDG SELF ADHESIVE 3" STERILE
|
Facility
|
OP
|
$15.01
|
|
| Hospital Charge Code |
901698115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.22
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.61
|
| Rate for Payer: Cigna of CA PPO |
$11.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.76
|
| Rate for Payer: Global Benefits Group Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.51
|
| Rate for Payer: Multiplan Commercial |
$12.01
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.76
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC BNDG SELF ADHESIVE 4" STERILE
|
Facility
|
OP
|
$19.02
|
|
| Hospital Charge Code |
901698116
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.68
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cigna of CA HMO |
$12.17
|
| Rate for Payer: Cigna of CA PPO |
$14.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.31
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Other HMO |
$9.51
|
| Rate for Payer: United Healthcare HMO Rider |
$9.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$16.17
|
|
|
HC BNDG SELF ADHESIVE 4" STERILE
|
Facility
|
IP
|
$19.02
|
|
| Hospital Charge Code |
901698116
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Senior |
$7.61
|
| Rate for Payer: Galaxy Health WC |
$16.17
|
| Rate for Payer: Global Benefits Group Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$15.22
|
| Rate for Payer: Networks By Design Commercial |
$12.36
|
| Rate for Payer: Prime Health Services Commercial |
$16.17
|
|
|
HC BNDG SELF ADHESIVE 6" STERILE
|
Facility
|
IP
|
$22.14
|
|
| Hospital Charge Code |
901698117
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Adventist Health Commercial |
$4.43
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.86
|
| Rate for Payer: EPIC Health Plan Senior |
$8.86
|
| Rate for Payer: Galaxy Health WC |
$18.82
|
| Rate for Payer: Global Benefits Group Commercial |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Multiplan Commercial |
$17.71
|
| Rate for Payer: Networks By Design Commercial |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$18.82
|
|
|
HC BNDG SELF ADHESIVE 6" STERILE
|
Facility
|
OP
|
$22.14
|
|
| Hospital Charge Code |
901698117
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.82 |
| Rate for Payer: Adventist Health Commercial |
$4.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.60
|
| Rate for Payer: Cash Price |
$9.96
|
| Rate for Payer: Cigna of CA HMO |
$14.17
|
| Rate for Payer: Cigna of CA PPO |
$16.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.86
|
| Rate for Payer: EPIC Health Plan Senior |
$8.86
|
| Rate for Payer: Galaxy Health WC |
$18.82
|
| Rate for Payer: Global Benefits Group Commercial |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$17.71
|
| Rate for Payer: Networks By Design Commercial |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$18.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.07
|
| Rate for Payer: United Healthcare All Other HMO |
$11.07
|
| Rate for Payer: United Healthcare HMO Rider |
$11.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.82
|
| Rate for Payer: Vantage Medical Group Senior |
$18.82
|
|
|
HC BNDG WRAP COBAN 6" X 5YD TAN
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT A6455
|
| Hospital Charge Code |
901698891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: Galaxy Health WC |
$27.74
|
| Rate for Payer: Global Benefits Group Commercial |
$19.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.83
|
| Rate for Payer: Multiplan Commercial |
$26.11
|
| Rate for Payer: Networks By Design Commercial |
$21.22
|
| Rate for Payer: Prime Health Services Commercial |
$27.74
|
|
