|
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 |
$55.22 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| 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 Exchange |
$6.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.72
|
| Rate for Payer: Blue Shield of California Commercial |
$8.42
|
| Rate for Payer: Blue Shield of California EPN |
$5.30
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Central Health Plan Commercial |
$10.62
|
| 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: Health Management Network EPO/PPO |
$11.95
|
| 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 |
$2.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.30
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$5.31
|
| 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 |
$13.72 |
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Central Health Plan Commercial |
$12.20
|
| 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: Health Management Network EPO/PPO |
$13.72
|
| 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 |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$11.44
|
| 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 |
$55.22 |
| Rate for Payer: Adventist Health Commercial |
$3.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| 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 Exchange |
$7.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.87
|
| Rate for Payer: Blue Shield of California Commercial |
$9.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.08
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Central Health Plan Commercial |
$12.20
|
| 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: Health Management Network EPO/PPO |
$13.72
|
| 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 |
$3.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$11.44
|
| Rate for Payer: Networks By Design Commercial |
$9.91
|
| Rate for Payer: Prime Health Services Commercial |
$12.96
|
| Rate for Payer: Riverside University Health System MISP |
$6.10
|
| 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 |
$29.38 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Central Health Plan Commercial |
$26.11
|
| 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: Health Management Network EPO/PPO |
$29.38
|
| 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 |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| 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 |
$3.50 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.50
|
| 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 Exchange |
$15.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.99
|
| Rate for Payer: Blue Shield of California Commercial |
$20.69
|
| Rate for Payer: Blue Shield of California EPN |
$13.02
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Central Health Plan Commercial |
$26.11
|
| 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: Health Management Network EPO/PPO |
$29.38
|
| 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 |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.85
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$21.22
|
| Rate for Payer: Prime Health Services Commercial |
$27.74
|
| Rate for Payer: Riverside University Health System MISP |
$13.06
|
| 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 |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| 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: Health Management Network EPO/PPO |
$0.59
|
| 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 |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| 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 |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.40
|
| 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 Exchange |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| 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: Health Management Network EPO/PPO |
$0.59
|
| 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 |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Riverside University Health System MISP |
$0.26
|
| 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 |
$7.61 |
| Rate for Payer: Adventist Health Commercial |
$1.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.13
|
| 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 Exchange |
$4.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.92
|
| Rate for Payer: Blue Shield of California Commercial |
$5.36
|
| Rate for Payer: Blue Shield of California EPN |
$3.37
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Central Health Plan Commercial |
$6.76
|
| 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: Health Management Network EPO/PPO |
$7.61
|
| 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 |
$1.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.92
|
| Rate for Payer: Multiplan Commercial |
$6.34
|
| Rate for Payer: Networks By Design Commercial |
$5.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.18
|
| Rate for Payer: Riverside University Health System MISP |
$3.38
|
| 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 |
$7.61 |
| Rate for Payer: Adventist Health Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Central Health Plan Commercial |
$6.76
|
| 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: Health Management Network EPO/PPO |
$7.61
|
| 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 |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$6.34
|
| 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 |
$13.58 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Cash Price |
$6.79
|
| Rate for Payer: Central Health Plan Commercial |
$12.07
|
| 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: Health Management Network EPO/PPO |
$13.58
|
| 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 |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$11.32
|
| 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 |
$13.58 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.16
|
| 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 Exchange |
$7.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.78
|
| Rate for Payer: Blue Shield of California Commercial |
$9.57
|
| Rate for Payer: Blue Shield of California EPN |
$6.02
|
| Rate for Payer: Cash Price |
$6.79
|
| Rate for Payer: Central Health Plan Commercial |
$12.07
|
| 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: Health Management Network EPO/PPO |
$13.58
|
| 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 |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.56
|
| Rate for Payer: Multiplan Commercial |
$11.32
|
| Rate for Payer: Networks By Design Commercial |
$9.81
|
| Rate for Payer: Prime Health Services Commercial |
$12.83
|
| Rate for Payer: Riverside University Health System MISP |
$6.04
|
| 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
|
OP
|
$17.47
|
|
| Hospital Charge Code |
901698917
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.61
|
| 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 Exchange |
$8.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.16
|
| Rate for Payer: Blue Shield of California Commercial |
$11.08
|
| Rate for Payer: Blue Shield of California EPN |
$6.97
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Central Health Plan Commercial |
$13.98
|
| 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: Health Management Network EPO/PPO |
$15.72
|
| 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 |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Networks By Design Commercial |
$11.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: Riverside University Health System MISP |
$6.99
|
| 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 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 |
$15.72 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Central Health Plan Commercial |
$13.98
|
| 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: Health Management Network EPO/PPO |
$15.72
|
| 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 |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Networks By Design Commercial |
$11.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
|
|
HC BNDR ABD 12" 3 PANEL 30-45"
|
Facility
|
OP
|
$110.35
|
|
| Hospital Charge Code |
901607298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.07 |
| Max. Negotiated Rate |
$99.31 |
| Rate for Payer: Adventist Health Commercial |
$22.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.19
|
| Rate for Payer: Blue Shield of California Commercial |
$69.96
|
| Rate for Payer: Blue Shield of California EPN |
$44.03
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Central Health Plan Commercial |
$88.28
|
| Rate for Payer: Cigna of CA HMO |
$70.62
|
| Rate for Payer: Cigna of CA PPO |
$81.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.14
|
| Rate for Payer: EPIC Health Plan Senior |
$44.14
|
| Rate for Payer: Galaxy Health WC |
$93.80
|
| Rate for Payer: Global Benefits Group Commercial |
$66.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.25
|
| Rate for Payer: Multiplan Commercial |
$82.76
|
| Rate for Payer: Networks By Design Commercial |
$71.73
|
| Rate for Payer: Prime Health Services Commercial |
$93.80
|
| Rate for Payer: Riverside University Health System MISP |
$44.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$55.17
|
| Rate for Payer: United Healthcare HMO Rider |
$55.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.80
|
| Rate for Payer: Vantage Medical Group Senior |
$93.80
|
|
|
HC BNDR ABD 12" 3 PANEL 30-45"
|
Facility
|
IP
|
$110.35
|
|
| Hospital Charge Code |
901607298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.07 |
| Max. Negotiated Rate |
$99.31 |
| Rate for Payer: Adventist Health Commercial |
$22.07
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Central Health Plan Commercial |
$88.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.14
|
| Rate for Payer: EPIC Health Plan Senior |
$44.14
|
| Rate for Payer: Galaxy Health WC |
$93.80
|
| Rate for Payer: Global Benefits Group Commercial |
$66.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.07
|
| Rate for Payer: Multiplan Commercial |
$82.76
|
| Rate for Payer: Networks By Design Commercial |
$71.73
|
| Rate for Payer: Prime Health Services Commercial |
$93.80
|
|
|
HC BNDR ABD 12" 3 PANEL 46-62"
|
Facility
|
IP
|
$113.16
|
|
| Hospital Charge Code |
901607299
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$101.84 |
| Rate for Payer: Adventist Health Commercial |
$22.63
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Central Health Plan Commercial |
$90.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.26
|
| Rate for Payer: EPIC Health Plan Senior |
$45.26
|
| Rate for Payer: Galaxy Health WC |
$96.19
|
| Rate for Payer: Global Benefits Group Commercial |
$67.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.63
|
| Rate for Payer: Multiplan Commercial |
$84.87
|
| Rate for Payer: Networks By Design Commercial |
$73.55
|
| Rate for Payer: Prime Health Services Commercial |
$96.19
|
|
|
HC BNDR ABD 12" 3 PANEL 46-62"
|
Facility
|
OP
|
$113.16
|
|
| Hospital Charge Code |
901607299
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$101.84 |
| Rate for Payer: Adventist Health Commercial |
$22.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.83
|
| Rate for Payer: Blue Shield of California Commercial |
$71.74
|
| Rate for Payer: Blue Shield of California EPN |
$45.15
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Central Health Plan Commercial |
$90.53
|
| Rate for Payer: Cigna of CA HMO |
$72.42
|
| Rate for Payer: Cigna of CA PPO |
$83.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.26
|
| Rate for Payer: EPIC Health Plan Senior |
$45.26
|
| Rate for Payer: Galaxy Health WC |
$96.19
|
| Rate for Payer: Global Benefits Group Commercial |
$67.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.21
|
| Rate for Payer: Multiplan Commercial |
$84.87
|
| Rate for Payer: Networks By Design Commercial |
$73.55
|
| Rate for Payer: Prime Health Services Commercial |
$96.19
|
| Rate for Payer: Riverside University Health System MISP |
$45.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.58
|
| Rate for Payer: United Healthcare All Other HMO |
$56.58
|
| Rate for Payer: United Healthcare HMO Rider |
$56.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.19
|
| Rate for Payer: Vantage Medical Group Senior |
$96.19
|
|
|
HC BNDR ABD 12" 4 PANEL 30-45"
|
Facility
|
IP
|
$97.43
|
|
| Hospital Charge Code |
901607296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$87.69 |
| Rate for Payer: Adventist Health Commercial |
$19.49
|
| Rate for Payer: Cash Price |
$43.84
|
| Rate for Payer: Central Health Plan Commercial |
$77.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.97
|
| Rate for Payer: EPIC Health Plan Senior |
$38.97
|
| Rate for Payer: Galaxy Health WC |
$82.82
|
| Rate for Payer: Global Benefits Group Commercial |
$58.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.49
|
| Rate for Payer: Multiplan Commercial |
$73.07
|
| Rate for Payer: Networks By Design Commercial |
$63.33
|
| Rate for Payer: Prime Health Services Commercial |
$82.82
|
|
|
HC BNDR ABD 12" 4 PANEL 30-45"
|
Facility
|
OP
|
$97.43
|
|
| Hospital Charge Code |
901607296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$87.69 |
| Rate for Payer: Adventist Health Commercial |
$19.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.68
|
| Rate for Payer: Blue Shield of California Commercial |
$61.77
|
| Rate for Payer: Blue Shield of California EPN |
$38.87
|
| Rate for Payer: Cash Price |
$43.84
|
| Rate for Payer: Central Health Plan Commercial |
$77.94
|
| Rate for Payer: Cigna of CA HMO |
$62.36
|
| Rate for Payer: Cigna of CA PPO |
$72.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.97
|
| Rate for Payer: EPIC Health Plan Senior |
$38.97
|
| Rate for Payer: Galaxy Health WC |
$82.82
|
| Rate for Payer: Global Benefits Group Commercial |
$58.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.20
|
| Rate for Payer: Multiplan Commercial |
$73.07
|
| Rate for Payer: Networks By Design Commercial |
$63.33
|
| Rate for Payer: Prime Health Services Commercial |
$82.82
|
| Rate for Payer: Riverside University Health System MISP |
$38.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.72
|
| Rate for Payer: United Healthcare All Other HMO |
$48.72
|
| Rate for Payer: United Healthcare HMO Rider |
$48.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.82
|
| Rate for Payer: Vantage Medical Group Senior |
$82.82
|
|
|
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 |
$53.06 |
| Rate for Payer: Adventist Health Commercial |
$11.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.81
|
| 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 Exchange |
$28.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.30
|
| Rate for Payer: Blue Shield of California Commercial |
$37.38
|
| Rate for Payer: Blue Shield of California EPN |
$23.53
|
| Rate for Payer: Cash Price |
$26.53
|
| Rate for Payer: Central Health Plan Commercial |
$47.17
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.27
|
| 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: Health Management Network EPO/PPO |
$53.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.27
|
| Rate for Payer: Multiplan Commercial |
$44.22
|
| Rate for Payer: Networks By Design Commercial |
$38.32
|
| Rate for Payer: Prime Health Services Commercial |
$50.12
|
| Rate for Payer: Riverside University Health System MISP |
$23.58
|
| 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 45-62"
|
Facility
|
IP
|
$58.96
|
|
| Hospital Charge Code |
901698628
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Adventist Health Commercial |
$11.79
|
| Rate for Payer: Cash Price |
$26.53
|
| Rate for Payer: Central Health Plan Commercial |
$47.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.27
|
| 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: Health Management Network EPO/PPO |
$53.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.79
|
| Rate for Payer: Multiplan Commercial |
$44.22
|
| Rate for Payer: Networks By Design Commercial |
$38.32
|
| Rate for Payer: Prime Health Services Commercial |
$50.12
|
|
|
HC BNDR ABD 12" 4 PANEL 46-62"
|
Facility
|
IP
|
$73.31
|
|
| Hospital Charge Code |
901607297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$65.98 |
| Rate for Payer: Adventist Health Commercial |
$14.66
|
| Rate for Payer: Cash Price |
$32.99
|
| Rate for Payer: Central Health Plan Commercial |
$58.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.32
|
| Rate for Payer: EPIC Health Plan Senior |
$29.32
|
| Rate for Payer: Galaxy Health WC |
$62.31
|
| Rate for Payer: Global Benefits Group Commercial |
$43.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.66
|
| Rate for Payer: Multiplan Commercial |
$54.98
|
| Rate for Payer: Networks By Design Commercial |
$47.65
|
| Rate for Payer: Prime Health Services Commercial |
$62.31
|
|
|
HC BNDR ABD 12" 4 PANEL 46-62"
|
Facility
|
OP
|
$73.31
|
|
| Hospital Charge Code |
901607297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$65.98 |
| Rate for Payer: Adventist Health Commercial |
$14.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.64
|
| Rate for Payer: Blue Shield of California Commercial |
$46.48
|
| Rate for Payer: Blue Shield of California EPN |
$29.25
|
| Rate for Payer: Cash Price |
$32.99
|
| Rate for Payer: Central Health Plan Commercial |
$58.65
|
| Rate for Payer: Cigna of CA HMO |
$46.92
|
| Rate for Payer: Cigna of CA PPO |
$54.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.32
|
| Rate for Payer: EPIC Health Plan Senior |
$29.32
|
| Rate for Payer: Galaxy Health WC |
$62.31
|
| Rate for Payer: Global Benefits Group Commercial |
$43.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.32
|
| Rate for Payer: Multiplan Commercial |
$54.98
|
| Rate for Payer: Networks By Design Commercial |
$47.65
|
| Rate for Payer: Prime Health Services Commercial |
$62.31
|
| Rate for Payer: Riverside University Health System MISP |
$29.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.66
|
| Rate for Payer: United Healthcare All Other HMO |
$36.66
|
| Rate for Payer: United Healthcare HMO Rider |
$36.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.31
|
| Rate for Payer: Vantage Medical Group Senior |
$62.31
|
|
|
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 |
$53.95 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Central Health Plan Commercial |
$47.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.96
|
| 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: Health Management Network EPO/PPO |
$53.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$44.95
|
| Rate for Payer: Networks By Design Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.95
|
|
|
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 |
$53.95 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.40
|
| 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 Exchange |
$29.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.87
|
| Rate for Payer: Blue Shield of California Commercial |
$38.00
|
| Rate for Payer: Blue Shield of California EPN |
$23.92
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Central Health Plan Commercial |
$47.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.96
|
| 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: Health Management Network EPO/PPO |
$53.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.96
|
| Rate for Payer: Multiplan Commercial |
$44.95
|
| Rate for Payer: Networks By Design Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.95
|
| Rate for Payer: Riverside University Health System MISP |
$23.98
|
| 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
|
|
