|
HC BNDG COHESIVE 1" X 5YR COLORED
|
Facility
IP
|
$3.28
|
|
| Hospital Charge Code |
901698147
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
|
|
HC BNDG COHESIVE 1" X 5YR COLORED
|
Facility
OP
|
$3.28
|
|
| Hospital Charge Code |
901698147
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.94
|
| Rate for Payer: BCBS Transplant Transplant |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.46
|
| Rate for Payer: IEHP medi-cal |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: Riverside University Health MISP |
$1.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.79
|
|
|
HC BNDG COHESIVE 2" COLORED
|
Facility
OP
|
$3.94
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698605
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.33
|
| Rate for Payer: BCBS Transplant Transplant |
$2.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2.48
|
| Rate for Payer: Blue Shield of California EPN |
$1.93
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Central Health Plan Commercial |
$3.15
|
| Rate for Payer: Cigna of CA HMO |
$2.52
|
| Rate for Payer: Cigna of CA PPO |
$2.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.96
|
| Rate for Payer: IEHP medi-cal |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.96
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.36
|
| Rate for Payer: Riverside University Health MISP |
$1.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.97
|
| Rate for Payer: United Healthcare All Other HMO |
$1.97
|
| Rate for Payer: United Healthcare HMO Rider |
$1.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.35
|
| Rate for Payer: Vantage Medical Group Senior |
$3.35
|
|
|
HC BNDG COHESIVE 2" COLORED
|
Facility
IP
|
$3.94
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698605
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Central Health Plan Commercial |
$3.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.58
|
| Rate for Payer: Galaxy Health WC |
$3.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$2.96
|
| Rate for Payer: Networks By Design Commercial |
$2.56
|
| Rate for Payer: Prime Health Services Commercial |
$3.35
|
|
|
HC BNDG COHESIVE 2" COLORED NS
|
Facility
OP
|
$4.10
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698395
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.42
|
| Rate for Payer: BCBS Transplant Transplant |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2.58
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.08
|
| Rate for Payer: IEHP medi-cal |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.66
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: Riverside University Health MISP |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC BNDG COHESIVE 2" COLORED NS
|
Facility
IP
|
$4.10
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698395
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.66
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC BNDG COHESIVE 2" X 5YD COLORED
|
Facility
OP
|
$5.33
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901607376
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.15
|
| Rate for Payer: BCBS Transplant Transplant |
$3.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.61
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Central Health Plan Commercial |
$4.26
|
| Rate for Payer: Cigna of CA HMO |
$3.41
|
| Rate for Payer: Cigna of CA PPO |
$3.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.00
|
| Rate for Payer: IEHP medi-cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.20
|
| Rate for Payer: Riverside University Health MISP |
$2.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4.53
|
|
|
HC BNDG COHESIVE 2" X 5YD COLORED
|
Facility
IP
|
$5.33
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901607376
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Central Health Plan Commercial |
$4.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
|
|
HC BNDG COHESIVE 2" X 5YD TAN
|
Facility
IP
|
$5.25
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901607378
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Central Health Plan Commercial |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$3.50
|
| 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 COHESIVE 2" X 5YD TAN
|
Facility
OP
|
$5.25
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901607378
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.10
|
| Rate for Payer: BCBS Transplant Transplant |
$3.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3.30
|
| Rate for Payer: Blue Shield of California EPN |
$2.57
|
| 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: EPIC Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$3.94
|
| Rate for Payer: IEHP medi-cal |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.50
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.15
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$4.46
|
| Rate for Payer: Vantage Medical Group Senior |
$4.46
|
|
|
HC BNDG COHESIVE 2"X5YD TAN NS
|
Facility
IP
|
$4.10
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698394
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.66
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC BNDG COHESIVE 2"X5YD TAN NS
|
Facility
OP
|
$4.10
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698394
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.42
|
| Rate for Payer: BCBS Transplant Transplant |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2.58
|
| Rate for Payer: Blue Shield of California EPN |
$2.00
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.08
|
| Rate for Payer: IEHP medi-cal |
$1.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.66
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: Riverside University Health MISP |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC BNDG COHESIVE 2"X5YD TAN STERL
|
Facility
IP
|
$5.33
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Central Health Plan Commercial |
$4.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
|
|
HC BNDG COHESIVE 2"X5YD TAN STERL
|
Facility
OP
|
$5.33
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698489
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.93
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.15
|
| Rate for Payer: BCBS Transplant Transplant |
$3.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.61
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Central Health Plan Commercial |
$4.26
|
| Rate for Payer: Cigna of CA HMO |
$3.41
|
| Rate for Payer: Cigna of CA PPO |
$3.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.00
|
| Rate for Payer: IEHP medi-cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.20
|
| Rate for Payer: Riverside University Health MISP |
$2.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.53
|
| Rate for Payer: Vantage Medical Group Senior |
$4.53
|
|
|
HC BNDG COHESIVE 3" STERILE
|
Facility
OP
|
$16.56
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901607573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.78
|
| Rate for Payer: BCBS Transplant Transplant |
$9.94
|
| Rate for Payer: Blue Shield of California Commercial |
$10.42
|
| Rate for Payer: Blue Shield of California EPN |
$8.10
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.42
|
| Rate for Payer: IEHP medi-cal |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: Riverside University Health MISP |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
HC BNDG COHESIVE 3" STERILE
|
Facility
IP
|
$16.56
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901607573
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
HC BNDG COHESIVE 3" STERILE
|
Facility
IP
|
$7.71
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$6.94 |
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Central Health Plan Commercial |
$6.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: Galaxy Health WC |
$6.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.78
|
| Rate for Payer: Networks By Design Commercial |
$5.01
|
| Rate for Payer: Prime Health Services Commercial |
$6.55
|
|
|
HC BNDG COHESIVE 3" STERILE
|
Facility
OP
|
$7.71
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$6.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.56
|
| Rate for Payer: BCBS Transplant Transplant |
$4.63
|
| Rate for Payer: Blue Shield of California Commercial |
$4.85
|
| Rate for Payer: Blue Shield of California EPN |
$3.77
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Central Health Plan Commercial |
$6.17
|
| Rate for Payer: Cigna of CA HMO |
$4.93
|
| Rate for Payer: Cigna of CA PPO |
$5.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.08
|
| Rate for Payer: Galaxy Health WC |
$6.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.94
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.78
|
| Rate for Payer: IEHP medi-cal |
$2.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.54
|
| Rate for Payer: Multiplan Commercial |
$5.78
|
| Rate for Payer: Networks By Design Commercial |
$5.01
|
| Rate for Payer: Prime Health Services Commercial |
$6.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.63
|
| Rate for Payer: Riverside University Health MISP |
$3.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.86
|
| Rate for Payer: United Healthcare All Other HMO |
$3.86
|
| Rate for Payer: United Healthcare HMO Rider |
$3.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.55
|
| Rate for Payer: Vantage Medical Group Senior |
$6.55
|
|
|
HC BNDG COHESIVE 3"X5YD COLOR NS
|
Facility
OP
|
$6.48
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.83
|
| Rate for Payer: BCBS Transplant Transplant |
$3.89
|
| Rate for Payer: Blue Shield of California Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Central Health Plan Commercial |
$5.18
|
| Rate for Payer: Cigna of CA HMO |
$4.15
|
| Rate for Payer: Cigna of CA PPO |
$4.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.59
|
| Rate for Payer: Galaxy Health WC |
$5.51
|
| Rate for Payer: Global Benefits Group Commercial |
$3.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.86
|
| Rate for Payer: IEHP medi-cal |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$4.21
|
| Rate for Payer: Prime Health Services Commercial |
$5.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.89
|
| Rate for Payer: Riverside University Health MISP |
$2.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.51
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
|
HC BNDG COHESIVE 3"X5YD COLOR NS
|
Facility
IP
|
$6.48
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Central Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.59
|
| Rate for Payer: Galaxy Health WC |
$5.51
|
| Rate for Payer: Global Benefits Group Commercial |
$3.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$4.21
|
| Rate for Payer: Prime Health Services Commercial |
$5.51
|
|
|
HC BNDG COHESIVE 3" X 5YD TAN
|
Facility
IP
|
$7.30
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901607545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Central Health Plan Commercial |
$5.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: Galaxy Health WC |
$6.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: Multiplan Commercial |
$5.48
|
| Rate for Payer: Networks By Design Commercial |
$4.74
|
| Rate for Payer: Prime Health Services Commercial |
$6.20
|
|
|
HC BNDG COHESIVE 3" X 5YD TAN
|
Facility
OP
|
$7.30
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901607545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.31
|
| Rate for Payer: BCBS Transplant Transplant |
$4.38
|
| Rate for Payer: Blue Shield of California Commercial |
$4.59
|
| Rate for Payer: Blue Shield of California EPN |
$3.57
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Central Health Plan Commercial |
$5.84
|
| Rate for Payer: Cigna of CA HMO |
$4.67
|
| Rate for Payer: Cigna of CA PPO |
$5.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.92
|
| Rate for Payer: Galaxy Health WC |
$6.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.48
|
| Rate for Payer: IEHP medi-cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: Multiplan Commercial |
$5.48
|
| Rate for Payer: Networks By Design Commercial |
$4.74
|
| Rate for Payer: Prime Health Services Commercial |
$6.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.38
|
| Rate for Payer: Riverside University Health MISP |
$2.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.65
|
| Rate for Payer: United Healthcare All Other HMO |
$3.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.20
|
| Rate for Payer: Vantage Medical Group Senior |
$6.20
|
|
|
HC BNDG COHESIVE 3"X5YD TAN NS
|
Facility
OP
|
$6.48
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698396
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.83
|
| Rate for Payer: BCBS Transplant Transplant |
$3.89
|
| Rate for Payer: Blue Shield of California Commercial |
$4.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Central Health Plan Commercial |
$5.18
|
| Rate for Payer: Cigna of CA HMO |
$4.15
|
| Rate for Payer: Cigna of CA PPO |
$4.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.59
|
| Rate for Payer: Galaxy Health WC |
$5.51
|
| Rate for Payer: Global Benefits Group Commercial |
$3.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.83
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.86
|
| Rate for Payer: IEHP medi-cal |
$2.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$4.21
|
| Rate for Payer: Prime Health Services Commercial |
$5.51
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.89
|
| Rate for Payer: Riverside University Health MISP |
$2.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.51
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
|
HC BNDG COHESIVE 3"X5YD TAN NS
|
Facility
IP
|
$6.48
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698396
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Central Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.59
|
| Rate for Payer: Galaxy Health WC |
$5.51
|
| Rate for Payer: Global Benefits Group Commercial |
$3.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$4.21
|
| Rate for Payer: Prime Health Services Commercial |
$5.51
|
|
|
HC BNDG COHESIVE 3" X 5YR COLORED
|
Facility
IP
|
$7.46
|
|
| Hospital Charge Code |
901698148
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Central Health Plan Commercial |
$5.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: Galaxy Health WC |
$6.34
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.85
|
| Rate for Payer: Prime Health Services Commercial |
$6.34
|
|
