|
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 |
$62.57 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.57
|
| 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 |
$3.95
|
| Rate for Payer: Cash Price |
$2.77
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.63
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.46
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.29
|
| 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 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 |
$62.57 |
| Rate for Payer: Adventist Health Commercial |
$2.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.57
|
| 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 |
$6.84
|
| Rate for Payer: Cash Price |
$4.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.46
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.29
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.84
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| 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 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 |
$62.57 |
| Rate for Payer: Cash Price |
$5.68
|
| 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: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.57
|
| 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 |
$8.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.84
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.84
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| 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 |
$62.57 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.57
|
| 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 |
$8.10
|
| Rate for Payer: Cash Price |
$5.68
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.84
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.84
|
| 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 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 |
$62.57 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.57
|
| 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 |
$8.52
|
| Rate for Payer: Cash Price |
$5.98
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.84
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.68
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.00
|
| 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 |
$62.57 |
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.57
|
| 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 |
$9.79
|
| Rate for Payer: Cash Price |
$6.86
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.68
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.00
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.85
|
| 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 Foundation Hospitals Commercial/Self Funded |
$20.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.26
|
| 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
|
|
|
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 |
$3.96 |
| Max. Negotiated Rate |
$27.74 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.96
|
| 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 |
$20.95
|
| Rate for Payer: Cash Price |
$14.69
|
| 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
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.85
|
| 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 Foundation Hospitals Commercial/Self Funded |
$20.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.26
|
| 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
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| 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 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 |
$0.42
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| 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 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 |
$5.42
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.92
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.99
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.92
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.99
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.56
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.90
|
| 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 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 |
$9.68
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.56
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.90
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.23
|
| 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 Foundation Hospitals Commercial/Self Funded |
$11.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.31
|
| 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 |
$11.21
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.23
|
| 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 Foundation Hospitals Commercial/Self Funded |
$11.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.31
|
| 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 |
$70.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.41
|
| 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 Foundation Hospitals Commercial/Self Funded |
$70.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.24
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.41
|
| 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 Foundation Hospitals Commercial/Self Funded |
$70.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.24
|
| 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
|
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 |
$72.76
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.37
|
| 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 Foundation Hospitals Commercial/Self Funded |
$72.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.90
|
| 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
|
|
