|
HC BNDG COHESIVE 3" X 5YR COLORED
|
Facility
OP
|
$7.46
|
|
| Hospital Charge Code |
901698148
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.41
|
| Rate for Payer: BCBS Transplant Transplant |
$4.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California EPN |
$3.65
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Central Health Plan Commercial |
$5.97
|
| Rate for Payer: Cigna of CA HMO |
$4.77
|
| Rate for Payer: Cigna of CA PPO |
$5.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$5.60
|
| Rate for Payer: IEHP medi-cal |
$2.61
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: Riverside University Health MISP |
$2.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.34
|
| Rate for Payer: Vantage Medical Group Senior |
$6.34
|
|
|
HC BNDG COHESIVE 4" STERILE
|
Facility
IP
|
$21.16
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901607574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Cash Price |
$9.52
|
| Rate for Payer: Central Health Plan Commercial |
$16.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
|
|
HC BNDG COHESIVE 4" STERILE
|
Facility
OP
|
$21.16
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901607574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.50
|
| Rate for Payer: BCBS Transplant Transplant |
$12.70
|
| Rate for Payer: Blue Shield of California Commercial |
$13.31
|
| Rate for Payer: Blue Shield of California EPN |
$10.35
|
| Rate for Payer: Cash Price |
$9.52
|
| Rate for Payer: Cash Price |
$9.52
|
| Rate for Payer: Central Health Plan Commercial |
$16.93
|
| Rate for Payer: Cigna of CA HMO |
$13.54
|
| Rate for Payer: Cigna of CA PPO |
$15.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.87
|
| Rate for Payer: IEHP medi-cal |
$7.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$13.75
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.70
|
| Rate for Payer: Riverside University Health MISP |
$8.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.99
|
| Rate for Payer: Vantage Medical Group Senior |
$17.99
|
|
|
HC BNDG COHESIVE 4" TAN NON STERL
|
Facility
IP
|
$8.53
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698399
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Central Health Plan Commercial |
$6.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
|
|
HC BNDG COHESIVE 4" TAN NON STERL
|
Facility
OP
|
$8.53
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698399
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.04
|
| Rate for Payer: BCBS Transplant Transplant |
$5.12
|
| Rate for Payer: Blue Shield of California Commercial |
$5.37
|
| Rate for Payer: Blue Shield of California EPN |
$4.17
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Central Health Plan Commercial |
$6.82
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$6.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.40
|
| Rate for Payer: IEHP medi-cal |
$2.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: Riverside University Health MISP |
$3.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Other HMO |
$4.26
|
| Rate for Payer: United Healthcare HMO Rider |
$4.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7.25
|
|
|
HC BNDG COHESIVE 4" TAN STERILE
|
Facility
IP
|
$10.99
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$9.89 |
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.34
|
| Rate for Payer: Global Benefits Group Commercial |
$6.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.24
|
| Rate for Payer: Networks By Design Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$9.34
|
|
|
HC BNDG COHESIVE 4" TAN STERILE
|
Facility
OP
|
$10.99
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901698400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$9.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.49
|
| Rate for Payer: BCBS Transplant Transplant |
$6.59
|
| Rate for Payer: Blue Shield of California Commercial |
$6.91
|
| Rate for Payer: Blue Shield of California EPN |
$5.37
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Central Health Plan Commercial |
$8.79
|
| Rate for Payer: Cigna of CA HMO |
$7.03
|
| Rate for Payer: Cigna of CA PPO |
$8.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$9.34
|
| Rate for Payer: Global Benefits Group Commercial |
$6.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.24
|
| Rate for Payer: IEHP medi-cal |
$3.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$8.24
|
| Rate for Payer: Networks By Design Commercial |
$7.14
|
| Rate for Payer: Prime Health Services Commercial |
$9.34
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.59
|
| Rate for Payer: Riverside University Health MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.34
|
| Rate for Payer: Vantage Medical Group Senior |
$9.34
|
|
|
HC BNDG COHESIVE 4" X 5YD TAN
|
Facility
OP
|
$10.41
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901607544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.15
|
| Rate for Payer: BCBS Transplant Transplant |
$6.25
|
| Rate for Payer: Blue Shield of California Commercial |
$6.55
|
| Rate for Payer: Blue Shield of California EPN |
$5.09
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Central Health Plan Commercial |
$8.33
|
| Rate for Payer: Cigna of CA HMO |
$6.66
|
| Rate for Payer: Cigna of CA PPO |
$7.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.16
|
| Rate for Payer: Galaxy Health WC |
$8.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.81
|
| Rate for Payer: IEHP medi-cal |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$7.81
|
| Rate for Payer: Networks By Design Commercial |
$6.77
|
| Rate for Payer: Prime Health Services Commercial |
$8.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.25
|
| Rate for Payer: Riverside University Health MISP |
$4.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.20
|
| Rate for Payer: United Healthcare All Other HMO |
$5.20
|
| Rate for Payer: United Healthcare HMO Rider |
$5.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8.85
|
|
|
HC BNDG COHESIVE 4" X 5YD TAN
|
Facility
IP
|
$10.41
|
|
|
Service Code
|
CPT A6454
|
| Hospital Charge Code |
901607544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$9.37 |
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Central Health Plan Commercial |
$8.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.16
|
| Rate for Payer: Galaxy Health WC |
$8.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$7.81
|
| Rate for Payer: Networks By Design Commercial |
$6.77
|
| Rate for Payer: Prime Health Services Commercial |
$8.85
|
|
|
HC BNDG COHESIVE 6" STERILE
|
Facility
IP
|
$25.91
|
|
|
Service Code
|
CPT A6455
|
| Hospital Charge Code |
901607575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Central Health Plan Commercial |
$20.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: Galaxy Health WC |
$22.02
|
| Rate for Payer: Global Benefits Group Commercial |
$15.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$19.43
|
| Rate for Payer: Networks By Design Commercial |
$16.84
|
| Rate for Payer: Prime Health Services Commercial |
$22.02
|
|
|
HC BNDG COHESIVE 6" STERILE
|
Facility
OP
|
$25.91
|
|
|
Service Code
|
CPT A6455
|
| Hospital Charge Code |
901607575
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.31
|
| Rate for Payer: BCBS Transplant Transplant |
$15.55
|
| Rate for Payer: Blue Shield of California Commercial |
$16.30
|
| Rate for Payer: Blue Shield of California EPN |
$12.67
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Central Health Plan Commercial |
$20.73
|
| Rate for Payer: Cigna of CA HMO |
$16.58
|
| Rate for Payer: Cigna of CA PPO |
$19.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.36
|
| Rate for Payer: Galaxy Health WC |
$22.02
|
| Rate for Payer: Global Benefits Group Commercial |
$15.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.43
|
| Rate for Payer: IEHP medi-cal |
$9.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$19.43
|
| Rate for Payer: Networks By Design Commercial |
$16.84
|
| Rate for Payer: Prime Health Services Commercial |
$22.02
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.55
|
| Rate for Payer: Riverside University Health MISP |
$10.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.96
|
| Rate for Payer: United Healthcare All Other HMO |
$12.96
|
| Rate for Payer: United Healthcare HMO Rider |
$12.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.02
|
| Rate for Payer: Vantage Medical Group Senior |
$22.02
|
|
|
HC BNDG COHESIVE 6" TAN STERILE
|
Facility
OP
|
$15.83
|
|
|
Service Code
|
CPT A6455
|
| Hospital Charge Code |
901698401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.35
|
| Rate for Payer: BCBS Transplant Transplant |
$9.50
|
| Rate for Payer: Blue Shield of California Commercial |
$9.96
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$10.13
|
| Rate for Payer: Cigna of CA PPO |
$11.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.87
|
| Rate for Payer: IEHP medi-cal |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$11.87
|
| Rate for Payer: Networks By Design Commercial |
$10.29
|
| Rate for Payer: Prime Health Services Commercial |
$13.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.50
|
| Rate for Payer: Riverside University Health MISP |
$6.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO |
$7.92
|
| Rate for Payer: United Healthcare HMO Rider |
$7.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Vantage Medical Group Senior |
$13.46
|
|
|
HC BNDG COHESIVE 6" TAN STERILE
|
Facility
IP
|
$15.83
|
|
|
Service Code
|
CPT A6455
|
| Hospital Charge Code |
901698401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$11.87
|
| Rate for Payer: Networks By Design Commercial |
$10.29
|
| Rate for Payer: Prime Health Services Commercial |
$13.46
|
|
|
HC BNDG COMPRESSION PROFORE
|
Facility
OP
|
$82.00
|
|
| Hospital Charge Code |
901604230
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: BCBS Transplant Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$61.50
|
| Rate for Payer: IEHP medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: Riverside University Health MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC BNDG COMPRESSION PROFORE
|
Facility
IP
|
$82.00
|
|
| Hospital Charge Code |
901604230
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC BNDG CONFORMING 1 X 75"
|
Facility
IP
|
$1.07
|
|
|
Service Code
|
CPT A6445
|
| Hospital Charge Code |
901607957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.91
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.91
|
|
|
HC BNDG CONFORMING 1 X 75"
|
Facility
OP
|
$1.07
|
|
|
Service Code
|
CPT A6445
|
| Hospital Charge Code |
901607957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.63
|
| Rate for Payer: BCBS Transplant Transplant |
$0.64
|
| Rate for Payer: Blue Shield of California Commercial |
$0.67
|
| Rate for Payer: Blue Shield of California EPN |
$0.52
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Central Health Plan Commercial |
$0.86
|
| Rate for Payer: Cigna of CA HMO |
$0.68
|
| Rate for Payer: Cigna of CA PPO |
$0.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.91
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.80
|
| Rate for Payer: IEHP medi-cal |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.21
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.91
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: Riverside University Health MISP |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: Vantage Medical Group Senior |
$0.91
|
|
|
HC BNDG CONFORMING 2 X 75"
|
Facility
OP
|
$1.31
|
|
|
Service Code
|
CPT A6445
|
| Hospital Charge Code |
901607958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.77
|
| Rate for Payer: BCBS Transplant Transplant |
$0.79
|
| Rate for Payer: Blue Shield of California Commercial |
$0.82
|
| Rate for Payer: Blue Shield of California EPN |
$0.64
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.05
|
| Rate for Payer: Cigna of CA HMO |
$0.84
|
| Rate for Payer: Cigna of CA PPO |
$0.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.98
|
| Rate for Payer: IEHP medi-cal |
$0.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: Riverside University Health MISP |
$0.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.66
|
| Rate for Payer: United Healthcare All Other HMO |
$0.66
|
| Rate for Payer: United Healthcare HMO Rider |
$0.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.11
|
| Rate for Payer: Vantage Medical Group Senior |
$1.11
|
|
|
HC BNDG CONFORMING 2 X 75"
|
Facility
IP
|
$1.31
|
|
|
Service Code
|
CPT A6445
|
| Hospital Charge Code |
901607958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Cash Price |
$0.59
|
| Rate for Payer: Central Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.52
|
| Rate for Payer: Galaxy Health WC |
$1.11
|
| Rate for Payer: Global Benefits Group Commercial |
$0.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.98
|
| Rate for Payer: Networks By Design Commercial |
$0.85
|
| Rate for Payer: Prime Health Services Commercial |
$1.11
|
|
|
HC BNDG CONFORMING 3 X 75"
|
Facility
IP
|
$1.80
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
HC BNDG CONFORMING 3 X 75"
|
Facility
OP
|
$1.80
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.06
|
| Rate for Payer: BCBS Transplant Transplant |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.35
|
| Rate for Payer: IEHP medi-cal |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: Riverside University Health MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
HC BNDG CONFORMING 4 X 75"
|
Facility
IP
|
$1.80
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
|
|
HC BNDG CONFORMING 4 X 75"
|
Facility
OP
|
$1.80
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.06
|
| Rate for Payer: BCBS Transplant Transplant |
$1.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1.13
|
| Rate for Payer: Blue Shield of California EPN |
$0.88
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Central Health Plan Commercial |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$1.15
|
| Rate for Payer: Cigna of CA PPO |
$1.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.72
|
| Rate for Payer: Galaxy Health WC |
$1.53
|
| Rate for Payer: Global Benefits Group Commercial |
$1.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1.35
|
| Rate for Payer: IEHP medi-cal |
$0.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.35
|
| Rate for Payer: Networks By Design Commercial |
$1.17
|
| Rate for Payer: Prime Health Services Commercial |
$1.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: Riverside University Health MISP |
$0.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1.53
|
|
|
HC BNDG ELASTIC 4" STR VELCRO LF
|
Facility
IP
|
$9.92
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
901607576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$8.43
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$7.44
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$8.43
|
|
|
HC BNDG ELASTIC 4" STR VELCRO LF
|
Facility
OP
|
$9.92
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
901607576
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.43
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.86
|
| Rate for Payer: BCBS Transplant Transplant |
$5.95
|
| Rate for Payer: Blue Shield of California Commercial |
$6.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.85
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.94
|
| Rate for Payer: Cigna of CA HMO |
$6.35
|
| Rate for Payer: Cigna of CA PPO |
$7.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$8.43
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.44
|
| Rate for Payer: IEHP medi-cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$7.44
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$8.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: Riverside University Health MISP |
$3.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.43
|
| Rate for Payer: Vantage Medical Group Senior |
$8.43
|
|
