|
HC BNDG WRAP COBAN 6" X 5YD TAN
|
Facility
|
OP
|
$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: Dignity Health Medi-Cal |
$27.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.74
|
| 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: Molina Healthcare of CA Medi-Cal |
$22.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.85
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.32
|
| Rate for Payer: United Healthcare All Other HMO |
$16.32
|
| Rate for Payer: United Healthcare HMO Rider |
$16.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.74
|
| Rate for Payer: Vantage Medical Group Senior |
$27.74
|
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.04
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cigna of CA HMO |
$20.89
|
| Rate for Payer: Cigna of CA PPO |
$24.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.74
|
|
|
HC BNDG XFAST PLASTER 2IN X 3YD
|
Facility
|
OP
|
$0.66
|
|
| Hospital Charge Code |
901698915
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.41
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
HC BNDG XFAST PLASTER 2IN X 3YD
|
Facility
|
IP
|
$0.66
|
|
| Hospital Charge Code |
901698915
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
|
|
HC BNDG XFAST PLASTER 3IN X 3YD
|
Facility
|
IP
|
$8.45
|
|
| Hospital Charge Code |
901698916
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Adventist Health Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: EPIC Health Plan Senior |
$3.38
|
| Rate for Payer: Galaxy Health WC |
$7.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$6.76
|
| Rate for Payer: Networks By Design Commercial |
$5.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.18
|
|
|
HC BNDG XFAST PLASTER 3IN X 3YD
|
Facility
|
OP
|
$8.45
|
|
| Hospital Charge Code |
901698916
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Adventist Health Commercial |
$1.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.19
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cigna of CA HMO |
$5.41
|
| Rate for Payer: Cigna of CA PPO |
$6.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: EPIC Health Plan Senior |
$3.38
|
| Rate for Payer: Galaxy Health WC |
$7.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.92
|
| Rate for Payer: Multiplan Commercial |
$6.76
|
| Rate for Payer: Networks By Design Commercial |
$5.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Other HMO |
$4.22
|
| Rate for Payer: United Healthcare HMO Rider |
$4.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Vantage Medical Group Senior |
$7.18
|
|
|
HC BNDG XFAST PLASTER 5IN X 5YD
|
Facility
|
OP
|
$15.09
|
|
| Hospital Charge Code |
901698918
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$12.83 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.27
|
| Rate for Payer: Cash Price |
$6.79
|
| Rate for Payer: Cigna of CA HMO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$11.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.04
|
| Rate for Payer: EPIC Health Plan Senior |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$12.83
|
| Rate for Payer: Global Benefits Group Commercial |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.56
|
| Rate for Payer: Multiplan Commercial |
$12.07
|
| Rate for Payer: Networks By Design Commercial |
$9.81
|
| Rate for Payer: Prime Health Services Commercial |
$12.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.54
|
| Rate for Payer: United Healthcare All Other HMO |
$7.54
|
| Rate for Payer: United Healthcare HMO Rider |
$7.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.83
|
| Rate for Payer: Vantage Medical Group Senior |
$12.83
|
|
|
HC BNDG XFAST PLASTER 5IN X 5YD
|
Facility
|
IP
|
$15.09
|
|
| Hospital Charge Code |
901698918
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$12.83 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Cash Price |
$6.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.04
|
| Rate for Payer: EPIC Health Plan Senior |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$12.83
|
| Rate for Payer: Global Benefits Group Commercial |
$9.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$12.07
|
| Rate for Payer: Networks By Design Commercial |
$9.81
|
| Rate for Payer: Prime Health Services Commercial |
$12.83
|
|
|
HC BNDG XFAST PLASTER 6IN X 5YD
|
Facility
|
IP
|
$17.47
|
|
| Hospital Charge Code |
901698917
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: Multiplan Commercial |
$13.98
|
| Rate for Payer: Networks By Design Commercial |
$11.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
|
|
HC BNDG XFAST PLASTER 6IN X 5YD
|
Facility
|
OP
|
$17.47
|
|
| Hospital Charge Code |
901698917
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.73
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$11.18
|
| Rate for Payer: Cigna of CA PPO |
$12.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$13.98
|
| Rate for Payer: Networks By Design Commercial |
$11.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.73
|
| Rate for Payer: United Healthcare All Other HMO |
$8.73
|
| Rate for Payer: United Healthcare HMO Rider |
$8.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.85
|
|
|
HC BNDR ABD 12" 3 PANEL 30-45"
|
Facility
|
OP
|
$110.58
|
|
| Hospital Charge Code |
901607298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$93.99 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.91
|
| Rate for Payer: Cash Price |
$49.76
|
| Rate for Payer: Cigna of CA HMO |
$70.77
|
| Rate for Payer: Cigna of CA PPO |
$81.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.23
|
| Rate for Payer: EPIC Health Plan Senior |
$44.23
|
| Rate for Payer: Galaxy Health WC |
$93.99
|
| Rate for Payer: Global Benefits Group Commercial |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.41
|
| Rate for Payer: Multiplan Commercial |
$88.46
|
| Rate for Payer: Networks By Design Commercial |
$71.88
|
| Rate for Payer: Prime Health Services Commercial |
$93.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.29
|
| Rate for Payer: United Healthcare All Other HMO |
$55.29
|
| Rate for Payer: United Healthcare HMO Rider |
$55.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.99
|
| Rate for Payer: Vantage Medical Group Senior |
$93.99
|
|
|
HC BNDR ABD 12" 3 PANEL 30-45"
|
Facility
|
IP
|
$110.58
|
|
| Hospital Charge Code |
901607298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$93.99 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Cash Price |
$49.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.23
|
| Rate for Payer: EPIC Health Plan Senior |
$44.23
|
| Rate for Payer: Galaxy Health WC |
$93.99
|
| Rate for Payer: Global Benefits Group Commercial |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.54
|
| Rate for Payer: Multiplan Commercial |
$88.46
|
| Rate for Payer: Networks By Design Commercial |
$71.88
|
| Rate for Payer: Prime Health Services Commercial |
$93.99
|
|
|
HC BNDR ABD 12" 3 PANEL 46-62"
|
Facility
|
IP
|
$113.39
|
|
| Hospital Charge Code |
901607299
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$96.38 |
| Rate for Payer: Adventist Health Commercial |
$22.68
|
| Rate for Payer: Cash Price |
$51.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.36
|
| Rate for Payer: EPIC Health Plan Senior |
$45.36
|
| Rate for Payer: Galaxy Health WC |
$96.38
|
| Rate for Payer: Global Benefits Group Commercial |
$68.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.21
|
| Rate for Payer: Multiplan Commercial |
$90.71
|
| Rate for Payer: Networks By Design Commercial |
$73.70
|
| Rate for Payer: Prime Health Services Commercial |
$96.38
|
|
|
HC BNDR ABD 12" 3 PANEL 46-62"
|
Facility
|
OP
|
$113.39
|
|
| Hospital Charge Code |
901607299
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$96.38 |
| Rate for Payer: Adventist Health Commercial |
$22.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.63
|
| Rate for Payer: Cash Price |
$51.03
|
| Rate for Payer: Cigna of CA HMO |
$72.57
|
| Rate for Payer: Cigna of CA PPO |
$83.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.36
|
| Rate for Payer: EPIC Health Plan Senior |
$45.36
|
| Rate for Payer: Galaxy Health WC |
$96.38
|
| Rate for Payer: Global Benefits Group Commercial |
$68.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.37
|
| Rate for Payer: Multiplan Commercial |
$90.71
|
| Rate for Payer: Networks By Design Commercial |
$73.70
|
| Rate for Payer: Prime Health Services Commercial |
$96.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.70
|
| Rate for Payer: United Healthcare All Other HMO |
$56.70
|
| Rate for Payer: United Healthcare HMO Rider |
$56.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.38
|
| Rate for Payer: Vantage Medical Group Senior |
$96.38
|
|
|
HC BNDR ABD 12" 4 PANEL 30-45"
|
Facility
|
OP
|
$97.66
|
|
| Hospital Charge Code |
901607296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$83.01 |
| Rate for Payer: Adventist Health Commercial |
$19.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.97
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cigna of CA HMO |
$62.50
|
| Rate for Payer: Cigna of CA PPO |
$72.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.06
|
| Rate for Payer: EPIC Health Plan Senior |
$39.06
|
| Rate for Payer: Galaxy Health WC |
$83.01
|
| Rate for Payer: Global Benefits Group Commercial |
$58.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.36
|
| Rate for Payer: Multiplan Commercial |
$78.13
|
| Rate for Payer: Networks By Design Commercial |
$63.48
|
| Rate for Payer: Prime Health Services Commercial |
$83.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.83
|
| Rate for Payer: United Healthcare All Other HMO |
$48.83
|
| Rate for Payer: United Healthcare HMO Rider |
$48.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.01
|
| Rate for Payer: Vantage Medical Group Senior |
$83.01
|
|
|
HC BNDR ABD 12" 4 PANEL 30-45"
|
Facility
|
IP
|
$97.66
|
|
| Hospital Charge Code |
901607296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$83.01 |
| Rate for Payer: Adventist Health Commercial |
$19.53
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.06
|
| Rate for Payer: EPIC Health Plan Senior |
$39.06
|
| Rate for Payer: Galaxy Health WC |
$83.01
|
| Rate for Payer: Global Benefits Group Commercial |
$58.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.44
|
| Rate for Payer: Multiplan Commercial |
$78.13
|
| Rate for Payer: Networks By Design Commercial |
$63.48
|
| Rate for Payer: Prime Health Services Commercial |
$83.01
|
|
|
HC BNDR ABD 12" 4 PANEL 45-62"
|
Facility
|
IP
|
$58.96
|
|
| Hospital Charge Code |
901698628
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$50.12 |
| Rate for Payer: Adventist Health Commercial |
$11.79
|
| Rate for Payer: Cash Price |
$26.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.58
|
| Rate for Payer: EPIC Health Plan Senior |
$23.58
|
| Rate for Payer: Galaxy Health WC |
$50.12
|
| Rate for Payer: Global Benefits Group Commercial |
$35.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.15
|
| Rate for Payer: Multiplan Commercial |
$47.17
|
| Rate for Payer: Networks By Design Commercial |
$38.32
|
| Rate for Payer: Prime Health Services Commercial |
$50.12
|
|
|
HC BNDR ABD 12" 4 PANEL 45-62"
|
Facility
|
OP
|
$58.96
|
|
| Hospital Charge Code |
901698628
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$50.12 |
| Rate for Payer: Adventist Health Commercial |
$11.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.21
|
| Rate for Payer: Cash Price |
$26.53
|
| Rate for Payer: Cigna of CA HMO |
$37.73
|
| Rate for Payer: Cigna of CA PPO |
$43.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.58
|
| Rate for Payer: EPIC Health Plan Senior |
$23.58
|
| Rate for Payer: Galaxy Health WC |
$50.12
|
| Rate for Payer: Global Benefits Group Commercial |
$35.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.27
|
| Rate for Payer: Multiplan Commercial |
$47.17
|
| Rate for Payer: Networks By Design Commercial |
$38.32
|
| Rate for Payer: Prime Health Services Commercial |
$50.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.48
|
| Rate for Payer: United Healthcare All Other HMO |
$29.48
|
| Rate for Payer: United Healthcare HMO Rider |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.12
|
|
|
HC BNDR ABD 12" 4 PANEL 46-62"
|
Facility
|
IP
|
$70.60
|
|
| Hospital Charge Code |
901607297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$60.01 |
| Rate for Payer: Adventist Health Commercial |
$14.12
|
| Rate for Payer: Cash Price |
$31.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.24
|
| Rate for Payer: EPIC Health Plan Senior |
$28.24
|
| Rate for Payer: Galaxy Health WC |
$60.01
|
| Rate for Payer: Global Benefits Group Commercial |
$42.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.94
|
| Rate for Payer: Multiplan Commercial |
$56.48
|
| Rate for Payer: Networks By Design Commercial |
$45.89
|
| Rate for Payer: Prime Health Services Commercial |
$60.01
|
|
|
HC BNDR ABD 12" 4 PANEL 46-62"
|
Facility
|
OP
|
$70.60
|
|
| Hospital Charge Code |
901607297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$60.01 |
| Rate for Payer: Adventist Health Commercial |
$14.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.36
|
| Rate for Payer: Cash Price |
$31.77
|
| Rate for Payer: Cigna of CA HMO |
$45.18
|
| Rate for Payer: Cigna of CA PPO |
$52.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.24
|
| Rate for Payer: EPIC Health Plan Senior |
$28.24
|
| Rate for Payer: Galaxy Health WC |
$60.01
|
| Rate for Payer: Global Benefits Group Commercial |
$42.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.42
|
| Rate for Payer: Multiplan Commercial |
$56.48
|
| Rate for Payer: Networks By Design Commercial |
$45.89
|
| Rate for Payer: Prime Health Services Commercial |
$60.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.30
|
| Rate for Payer: United Healthcare All Other HMO |
$35.30
|
| Rate for Payer: United Healthcare HMO Rider |
$35.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.01
|
| Rate for Payer: Vantage Medical Group Senior |
$60.01
|
|
|
HC BNDR ABD 12" MED-LRG 45-62"
|
Facility
|
OP
|
$59.94
|
|
| Hospital Charge Code |
901698627
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$50.95 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.81
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Cigna of CA HMO |
$38.36
|
| Rate for Payer: Cigna of CA PPO |
$44.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.98
|
| Rate for Payer: EPIC Health Plan Senior |
$23.98
|
| Rate for Payer: Galaxy Health WC |
$50.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.96
|
| Rate for Payer: Multiplan Commercial |
$47.95
|
| Rate for Payer: Networks By Design Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.97
|
| Rate for Payer: United Healthcare All Other HMO |
$29.97
|
| Rate for Payer: United Healthcare HMO Rider |
$29.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.95
|
| Rate for Payer: Vantage Medical Group Senior |
$50.95
|
|
|
HC BNDR ABD 12" MED-LRG 45-62"
|
Facility
|
IP
|
$59.94
|
|
| Hospital Charge Code |
901698627
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$50.95 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.98
|
| Rate for Payer: EPIC Health Plan Senior |
$23.98
|
| Rate for Payer: Galaxy Health WC |
$50.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$47.95
|
| Rate for Payer: Networks By Design Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.95
|
|
|
HC BNDR,ABD 2XL 72-84" 3 PANEL
|
Facility
|
IP
|
$58.79
|
|
| Hospital Charge Code |
901605883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$49.97 |
| Rate for Payer: Adventist Health Commercial |
$11.76
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.52
|
| Rate for Payer: EPIC Health Plan Senior |
$23.52
|
| Rate for Payer: Galaxy Health WC |
$49.97
|
| Rate for Payer: Global Benefits Group Commercial |
$35.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.11
|
| Rate for Payer: Multiplan Commercial |
$47.03
|
| Rate for Payer: Networks By Design Commercial |
$38.21
|
| Rate for Payer: Prime Health Services Commercial |
$49.97
|
|
|
HC BNDR,ABD 2XL 72-84" 3 PANEL
|
Facility
|
OP
|
$58.79
|
|
| Hospital Charge Code |
901605883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$49.97 |
| Rate for Payer: Adventist Health Commercial |
$11.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$49.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.10
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Cigna of CA HMO |
$37.63
|
| Rate for Payer: Cigna of CA PPO |
$43.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.52
|
| Rate for Payer: EPIC Health Plan Senior |
$23.52
|
| Rate for Payer: Galaxy Health WC |
$49.97
|
| Rate for Payer: Global Benefits Group Commercial |
$35.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.15
|
| Rate for Payer: Multiplan Commercial |
$47.03
|
| Rate for Payer: Networks By Design Commercial |
$38.21
|
| Rate for Payer: Prime Health Services Commercial |
$49.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.39
|
| Rate for Payer: United Healthcare All Other HMO |
$29.39
|
| Rate for Payer: United Healthcare HMO Rider |
$29.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$49.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.97
|
| Rate for Payer: Vantage Medical Group Senior |
$49.97
|
|
|
HC BNDR ABD 2XL 72-84" 4 PANEL
|
Facility
|
IP
|
$62.98
|
|
| Hospital Charge Code |
901605884
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$53.53 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.19
|
| Rate for Payer: EPIC Health Plan Senior |
$25.19
|
| Rate for Payer: Galaxy Health WC |
$53.53
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.38
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.53
|
|
|
HC BNDR ABD 2XL 72-84" 4 PANEL
|
Facility
|
OP
|
$62.98
|
|
| Hospital Charge Code |
901605884
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$53.53 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.68
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Cigna of CA HMO |
$40.31
|
| Rate for Payer: Cigna of CA PPO |
$46.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.19
|
| Rate for Payer: EPIC Health Plan Senior |
$25.19
|
| Rate for Payer: Galaxy Health WC |
$53.53
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.09
|
| Rate for Payer: Multiplan Commercial |
$50.38
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.49
|
| Rate for Payer: United Healthcare All Other HMO |
$31.49
|
| Rate for Payer: United Healthcare HMO Rider |
$31.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.53
|
| Rate for Payer: Vantage Medical Group Senior |
$53.53
|
|
