|
HC BNDG CONFORMING 3 X 75"
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Central Health Plan Commercial |
$1.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: Galaxy Health WC |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Prime Health Services Commercial |
$1.26
|
|
|
HC BNDG CONFORMING 3 X 75"
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Adventist Health Commercial |
$0.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.86
|
| Rate for Payer: Blue Shield of California Commercial |
$0.94
|
| Rate for Payer: Blue Shield of California EPN |
$0.59
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Central Health Plan Commercial |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$1.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.59
|
| Rate for Payer: EPIC Health Plan Senior |
$0.59
|
| Rate for Payer: Galaxy Health WC |
$1.26
|
| Rate for Payer: Global Benefits Group Commercial |
$0.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$1.11
|
| Rate for Payer: Networks By Design Commercial |
$0.96
|
| Rate for Payer: Prime Health Services Commercial |
$1.26
|
| Rate for Payer: Riverside University Health System MISP |
$0.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.74
|
| Rate for Payer: United Healthcare All Other HMO |
$0.74
|
| Rate for Payer: United Healthcare HMO Rider |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1.26
|
|
|
HC BNDG CONFORMING 4 X 75"
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.91
|
| Rate for Payer: Blue Shield of California Commercial |
$0.99
|
| Rate for Payer: Blue Shield of California EPN |
$0.62
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Central Health Plan Commercial |
$1.25
|
| Rate for Payer: Cigna of CA HMO |
$1.00
|
| Rate for Payer: Cigna of CA PPO |
$1.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.09
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
| Rate for Payer: Riverside University Health System MISP |
$0.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.78
|
| Rate for Payer: United Healthcare All Other HMO |
$0.78
|
| Rate for Payer: United Healthcare HMO Rider |
$0.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.33
|
| Rate for Payer: Vantage Medical Group Senior |
$1.33
|
|
|
HC BNDG CONFORMING 4 X 75"
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Adventist Health Commercial |
$0.31
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Central Health Plan Commercial |
$1.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.62
|
| Rate for Payer: EPIC Health Plan Senior |
$0.62
|
| Rate for Payer: Galaxy Health WC |
$1.33
|
| Rate for Payer: Global Benefits Group Commercial |
$0.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.31
|
| Rate for Payer: Multiplan Commercial |
$1.17
|
| Rate for Payer: Networks By Design Commercial |
$1.01
|
| Rate for Payer: Prime Health Services Commercial |
$1.33
|
|
|
HC BNDG ELASTIC 4" STR VELCRO LF
|
Facility
|
IP
|
$6.97
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
901607576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Central Health Plan Commercial |
$5.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$5.23
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
|
|
HC BNDG ELASTIC 4" STR VELCRO LF
|
Facility
|
OP
|
$6.97
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
901607576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Central Health Plan Commercial |
$5.58
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$5.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$5.23
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
| Rate for Payer: Riverside University Health System MISP |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.92
|
| Rate for Payer: Vantage Medical Group Senior |
$5.92
|
|
|
HC BNDG ELASTIC 6" STR VELCRO LF
|
Facility
|
OP
|
$8.86
|
|
|
Service Code
|
CPT A6450
|
| Hospital Charge Code |
901607577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$27.61 |
| Rate for Payer: Adventist Health Commercial |
$1.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.15
|
| Rate for Payer: Blue Shield of California Commercial |
$5.62
|
| Rate for Payer: Blue Shield of California EPN |
$3.54
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Central Health Plan Commercial |
$7.09
|
| Rate for Payer: Cigna of CA HMO |
$5.67
|
| Rate for Payer: Cigna of CA PPO |
$6.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.54
|
| Rate for Payer: EPIC Health Plan Senior |
$3.54
|
| Rate for Payer: Galaxy Health WC |
$7.53
|
| Rate for Payer: Global Benefits Group Commercial |
$5.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$6.64
|
| Rate for Payer: Networks By Design Commercial |
$5.76
|
| Rate for Payer: Prime Health Services Commercial |
$7.53
|
| Rate for Payer: Riverside University Health System MISP |
$3.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Other HMO |
$4.43
|
| Rate for Payer: United Healthcare HMO Rider |
$4.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.53
|
| Rate for Payer: Vantage Medical Group Senior |
$7.53
|
|
|
HC BNDG ELASTIC 6" STR VELCRO LF
|
Facility
|
IP
|
$8.86
|
|
|
Service Code
|
CPT A6450
|
| Hospital Charge Code |
901607577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Adventist Health Commercial |
$1.77
|
| Rate for Payer: Cash Price |
$3.99
|
| Rate for Payer: Central Health Plan Commercial |
$7.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.54
|
| Rate for Payer: EPIC Health Plan Senior |
$3.54
|
| Rate for Payer: Galaxy Health WC |
$7.53
|
| Rate for Payer: Global Benefits Group Commercial |
$5.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.77
|
| Rate for Payer: Multiplan Commercial |
$6.64
|
| Rate for Payer: Networks By Design Commercial |
$5.76
|
| Rate for Payer: Prime Health Services Commercial |
$7.53
|
|
|
HC BNDG ELASTIC STERL 2"X5YD CLSR
|
Facility
|
OP
|
$5.74
|
|
|
Service Code
|
CPT A6448
|
| Hospital Charge Code |
901698392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: Blue Shield of California Commercial |
$3.64
|
| Rate for Payer: Blue Shield of California EPN |
$2.29
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Central Health Plan Commercial |
$4.59
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$4.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
| Rate for Payer: Riverside University Health System MISP |
$2.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2.87
|
| Rate for Payer: United Healthcare HMO Rider |
$2.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC BNDG ELASTIC STERL 2"X5YD CLSR
|
Facility
|
IP
|
$5.74
|
|
|
Service Code
|
CPT A6448
|
| Hospital Charge Code |
901698392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Central Health Plan Commercial |
$4.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
|
|
HC BNDG ELASTIC STR 2" VELCRO LF
|
Facility
|
IP
|
$6.56
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
901607579
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$5.90 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Central Health Plan Commercial |
$5.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Senior |
$2.62
|
| Rate for Payer: Galaxy Health WC |
$5.58
|
| Rate for Payer: Global Benefits Group Commercial |
$3.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Multiplan Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$4.26
|
| Rate for Payer: Prime Health Services Commercial |
$5.58
|
|
|
HC BNDG ELASTIC STR 2" VELCRO LF
|
Facility
|
OP
|
$6.56
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
901607579
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$5.90 |
| Rate for Payer: Adventist Health Commercial |
$1.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.82
|
| Rate for Payer: Blue Shield of California Commercial |
$4.16
|
| Rate for Payer: Blue Shield of California EPN |
$2.62
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Central Health Plan Commercial |
$5.25
|
| Rate for Payer: Cigna of CA HMO |
$4.20
|
| Rate for Payer: Cigna of CA PPO |
$4.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Senior |
$2.62
|
| Rate for Payer: Galaxy Health WC |
$5.58
|
| Rate for Payer: Global Benefits Group Commercial |
$3.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.59
|
| Rate for Payer: Multiplan Commercial |
$4.92
|
| Rate for Payer: Networks By Design Commercial |
$4.26
|
| Rate for Payer: Prime Health Services Commercial |
$5.58
|
| Rate for Payer: Riverside University Health System MISP |
$2.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.28
|
| Rate for Payer: United Healthcare All Other HMO |
$3.28
|
| Rate for Payer: United Healthcare HMO Rider |
$3.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.58
|
| Rate for Payer: Vantage Medical Group Senior |
$5.58
|
|
|
HC BNDG ELASTIC STR 3" VELCRO LF
|
Facility
|
OP
|
$8.20
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
901607580
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Adventist Health Commercial |
$1.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.77
|
| Rate for Payer: Blue Shield of California Commercial |
$5.20
|
| Rate for Payer: Blue Shield of California EPN |
$3.27
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Central Health Plan Commercial |
$6.56
|
| Rate for Payer: Cigna of CA HMO |
$5.25
|
| Rate for Payer: Cigna of CA PPO |
$6.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Senior |
$3.28
|
| Rate for Payer: Galaxy Health WC |
$6.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$6.15
|
| Rate for Payer: Networks By Design Commercial |
$5.33
|
| Rate for Payer: Prime Health Services Commercial |
$6.97
|
| Rate for Payer: Riverside University Health System MISP |
$3.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.10
|
| Rate for Payer: United Healthcare All Other HMO |
$4.10
|
| Rate for Payer: United Healthcare HMO Rider |
$4.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.97
|
| Rate for Payer: Vantage Medical Group Senior |
$6.97
|
|
|
HC BNDG ELASTIC STR 3" VELCRO LF
|
Facility
|
IP
|
$8.20
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
901607580
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Adventist Health Commercial |
$1.64
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Central Health Plan Commercial |
$6.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Senior |
$3.28
|
| Rate for Payer: Galaxy Health WC |
$6.97
|
| Rate for Payer: Global Benefits Group Commercial |
$4.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$6.15
|
| Rate for Payer: Networks By Design Commercial |
$5.33
|
| Rate for Payer: Prime Health Services Commercial |
$6.97
|
|
|
HC BNDG PLASTER 2"
|
Facility
|
OP
|
$5.25
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605892
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$55.22 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3.33
|
| Rate for Payer: Blue Shield of California EPN |
$2.09
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Central Health Plan Commercial |
$4.20
|
| Rate for Payer: Cigna of CA HMO |
$3.36
|
| Rate for Payer: Cigna of CA PPO |
$3.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Senior |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$4.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Prime Health Services Commercial |
$4.46
|
| Rate for Payer: Riverside University Health System MISP |
$2.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.62
|
| Rate for Payer: United Healthcare All Other HMO |
$2.62
|
| Rate for Payer: United Healthcare HMO Rider |
$2.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.46
|
| Rate for Payer: Vantage Medical Group Senior |
$4.46
|
|
|
HC BNDG PLASTER 2"
|
Facility
|
IP
|
$5.25
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605892
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Adventist Health Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Central Health Plan Commercial |
$4.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Senior |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$4.46
|
| Rate for Payer: Global Benefits Group Commercial |
$3.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.05
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.41
|
| Rate for Payer: Prime Health Services Commercial |
$4.46
|
|
|
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 |
$5.54 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Central Health Plan Commercial |
$4.92
|
| 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: Health Management Network EPO/PPO |
$5.54
|
| 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 |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.61
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
|
|
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 |
$55.22 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| 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 Exchange |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Central Health Plan Commercial |
$4.92
|
| 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: Health Management Network EPO/PPO |
$5.54
|
| 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 |
$1.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$4.61
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
| Rate for Payer: Riverside University Health System MISP |
$2.46
|
| 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 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 |
$55.22 |
| Rate for Payer: Adventist Health Commercial |
$2.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| 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 Exchange |
$5.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6.76
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Central Health Plan Commercial |
$8.53
|
| 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: Health Management Network EPO/PPO |
$9.59
|
| 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 |
$2.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$9.06
|
| Rate for Payer: Riverside University Health System MISP |
$4.26
|
| 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 |
$9.59 |
| Rate for Payer: Adventist Health Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Central Health Plan Commercial |
$8.53
|
| 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: Health Management Network EPO/PPO |
$9.59
|
| 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 |
$2.13
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| 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 |
$55.22 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.35
|
| Rate for Payer: Blue Shield of California Commercial |
$8.01
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Central Health Plan Commercial |
$10.10
|
| Rate for Payer: Cigna of CA HMO |
$8.08
|
| Rate for Payer: Cigna of CA PPO |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: 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: Health Management Network EPO/PPO |
$11.37
|
| 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 |
$2.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.84
|
| Rate for Payer: Multiplan Commercial |
$9.47
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
| Rate for Payer: Riverside University Health System MISP |
$5.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.32
|
| Rate for Payer: United Healthcare All Other HMO |
$6.32
|
| Rate for Payer: United Healthcare HMO Rider |
$6.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC 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 |
$11.37 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Central Health Plan Commercial |
$10.10
|
| Rate for Payer: 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: Health Management Network EPO/PPO |
$11.37
|
| 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 |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$9.47
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
|
|
HC 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 |
$55.22 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.35
|
| Rate for Payer: Blue Shield of California Commercial |
$8.01
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Central Health Plan Commercial |
$10.10
|
| Rate for Payer: Cigna of CA HMO |
$8.08
|
| Rate for Payer: Cigna of CA PPO |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: 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: Health Management Network EPO/PPO |
$11.37
|
| 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 |
$2.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.84
|
| Rate for Payer: Multiplan Commercial |
$9.47
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
| Rate for Payer: Riverside University Health System MISP |
$5.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.32
|
| Rate for Payer: United Healthcare All Other HMO |
$6.32
|
| Rate for Payer: United Healthcare HMO Rider |
$6.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC 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 |
$11.37 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Central Health Plan Commercial |
$10.10
|
| Rate for Payer: 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: Health Management Network EPO/PPO |
$11.37
|
| 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 |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$9.47
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
|
|
HC 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 |
$11.95 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Central Health Plan Commercial |
$10.62
|
| 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: Health Management Network EPO/PPO |
$11.95
|
| 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 |
$2.66
|
| Rate for Payer: Multiplan Commercial |
$9.96
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
|
