|
HC BNDG ELASTIC 6" STR VELCRO LF
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
CPT A6450
|
| Hospital Charge Code |
901607577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
|
|
HC BNDG ELASTIC 6" STR VELCRO LF
|
Facility
|
OP
|
$12.30
|
|
|
Service Code
|
CPT A6450
|
| Hospital Charge Code |
901607577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$27.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.27
|
| Rate for Payer: Blue Distinction Transplant |
$7.38
|
| Rate for Payer: Blue Shield of California Commercial |
$7.74
|
| Rate for Payer: Blue Shield of California EPN |
$6.01
|
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: Cigna of CA HMO |
$7.87
|
| Rate for Payer: Cigna of CA PPO |
$9.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Media |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
| Rate for Payer: Riverside University Health System MISP |
$4.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.15
|
| Rate for Payer: United Healthcare All Other HMO |
$6.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
HC BNDG ELASTIC STERL 2"X5YD CLSR
|
Facility
|
IP
|
$5.74
|
|
|
Service Code
|
CPT A6448
|
| Hospital Charge Code |
901698392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Central Health Plan Commercial |
$4.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
|
|
HC BNDG ELASTIC STERL 2"X5YD CLSR
|
Facility
|
OP
|
$5.74
|
|
|
Service Code
|
CPT A6448
|
| Hospital Charge Code |
901698392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.39
|
| Rate for Payer: Blue Distinction Transplant |
$3.44
|
| Rate for Payer: Blue Shield of California Commercial |
$3.61
|
| Rate for Payer: Blue Shield of California EPN |
$2.81
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Central Health Plan Commercial |
$4.59
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$4.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.88
|
| Rate for Payer: Dignity Health Media |
$4.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$4.30
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
| Rate for Payer: Riverside University Health System MISP |
$2.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2.87
|
| Rate for Payer: United Healthcare HMO Rider |
$2.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC BNDG ELASTIC STR 2" VELCRO LF
|
Facility
|
IP
|
$9.35
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
901607579
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Central Health Plan Commercial |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$7.01
|
| Rate for Payer: Networks By Design Commercial |
$6.08
|
| Rate for Payer: Prime Health Services Commercial |
$7.95
|
|
|
HC BNDG ELASTIC STR 2" VELCRO LF
|
Facility
|
OP
|
$9.35
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
901607579
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.52
|
| Rate for Payer: Blue Distinction Transplant |
$5.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5.88
|
| Rate for Payer: Blue Shield of California EPN |
$4.57
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Central Health Plan Commercial |
$7.48
|
| Rate for Payer: Cigna of CA HMO |
$5.98
|
| Rate for Payer: Cigna of CA PPO |
$6.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.95
|
| Rate for Payer: Dignity Health Media |
$7.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$7.01
|
| Rate for Payer: Networks By Design Commercial |
$6.08
|
| Rate for Payer: Prime Health Services Commercial |
$7.95
|
| Rate for Payer: Riverside University Health System MISP |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7.95
|
|
|
HC BNDG ELASTIC STR 3" VELCRO LF
|
Facility
|
IP
|
$9.43
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
901607580
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.49 |
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Central Health Plan Commercial |
$7.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.77
|
| Rate for Payer: Galaxy Health WC |
$8.02
|
| Rate for Payer: Global Benefits Group Commercial |
$5.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$7.07
|
| Rate for Payer: Networks By Design Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$8.02
|
|
|
HC BNDG ELASTIC STR 3" VELCRO LF
|
Facility
|
OP
|
$9.43
|
|
|
Service Code
|
CPT A6449
|
| Hospital Charge Code |
901607580
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.57
|
| Rate for Payer: Blue Distinction Transplant |
$5.66
|
| Rate for Payer: Blue Shield of California Commercial |
$5.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.61
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Central Health Plan Commercial |
$7.54
|
| Rate for Payer: Cigna of CA HMO |
$6.04
|
| Rate for Payer: Cigna of CA PPO |
$6.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.02
|
| Rate for Payer: Dignity Health Media |
$8.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.77
|
| Rate for Payer: Galaxy Health WC |
$8.02
|
| Rate for Payer: Global Benefits Group Commercial |
$5.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$7.07
|
| Rate for Payer: Networks By Design Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$8.02
|
| Rate for Payer: Riverside University Health System MISP |
$3.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.02
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
HC BNDG PLASTER 2"
|
Facility
|
OP
|
$37.31
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605892
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$55.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.04
|
| Rate for Payer: Blue Distinction Transplant |
$22.39
|
| Rate for Payer: Blue Shield of California Commercial |
$23.47
|
| Rate for Payer: Blue Shield of California EPN |
$18.24
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Central Health Plan Commercial |
$29.85
|
| Rate for Payer: Cigna of CA HMO |
$23.88
|
| Rate for Payer: Cigna of CA PPO |
$27.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.71
|
| Rate for Payer: Dignity Health Media |
$31.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$27.98
|
| Rate for Payer: Networks By Design Commercial |
$24.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
| Rate for Payer: Riverside University Health System MISP |
$14.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.66
|
| Rate for Payer: United Healthcare All Other HMO |
$18.66
|
| Rate for Payer: United Healthcare HMO Rider |
$18.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.71
|
| Rate for Payer: Vantage Medical Group Senior |
$31.71
|
|
|
HC BNDG PLASTER 2"
|
Facility
|
IP
|
$37.31
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605892
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Central Health Plan Commercial |
$29.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$27.98
|
| Rate for Payer: Networks By Design Commercial |
$24.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
|
|
HC BNDG PLASTER 3"
|
Facility
|
OP
|
$5.99
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605893
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$55.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.54
|
| Rate for Payer: Blue Distinction Transplant |
$3.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3.77
|
| Rate for Payer: Blue Shield of California EPN |
$2.93
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.79
|
| Rate for Payer: Cigna of CA HMO |
$3.83
|
| Rate for Payer: Cigna of CA PPO |
$4.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.09
|
| Rate for Payer: Dignity Health Media |
$5.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
| Rate for Payer: Riverside University Health System MISP |
$2.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.09
|
| Rate for Payer: Vantage Medical Group Senior |
$5.09
|
|
|
HC BNDG PLASTER 3"
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605893
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Central Health Plan Commercial |
$4.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.09
|
| Rate for Payer: Global Benefits Group Commercial |
$3.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.49
|
| Rate for Payer: Networks By Design Commercial |
$3.89
|
| Rate for Payer: Prime Health Services Commercial |
$5.09
|
|
|
HC BNDG PLASTER 4"
|
Facility
|
OP
|
$8.69
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605894
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$55.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Blue Distinction Transplant |
$5.21
|
| Rate for Payer: Blue Shield of California Commercial |
$5.47
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: Central Health Plan Commercial |
$6.95
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$6.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.39
|
| Rate for Payer: Dignity Health Media |
$7.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.52
|
| Rate for Payer: Networks By Design Commercial |
$5.65
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
| Rate for Payer: Riverside University Health System MISP |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.39
|
| Rate for Payer: Vantage Medical Group Senior |
$7.39
|
|
|
HC BNDG PLASTER 4"
|
Facility
|
IP
|
$8.69
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605894
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: Central Health Plan Commercial |
$6.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.52
|
| Rate for Payer: Networks By Design Commercial |
$5.65
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
|
|
HC BNDG PLASTER 5"
|
Facility
|
IP
|
$10.50
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605895
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Central Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.20
|
| Rate for Payer: Galaxy Health WC |
$8.92
|
| Rate for Payer: Global Benefits Group Commercial |
$6.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.88
|
| Rate for Payer: Networks By Design Commercial |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$8.92
|
|
|
HC BNDG PLASTER 5"
|
Facility
|
OP
|
$10.50
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605895
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$55.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.20
|
| Rate for Payer: Blue Distinction Transplant |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.60
|
| Rate for Payer: Blue Shield of California EPN |
$5.13
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Central Health Plan Commercial |
$8.40
|
| Rate for Payer: Cigna of CA HMO |
$6.72
|
| Rate for Payer: Cigna of CA PPO |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.92
|
| Rate for Payer: Dignity Health Media |
$8.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.20
|
| Rate for Payer: Galaxy Health WC |
$8.92
|
| Rate for Payer: Global Benefits Group Commercial |
$6.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.88
|
| Rate for Payer: Networks By Design Commercial |
$6.82
|
| Rate for Payer: Prime Health Services Commercial |
$8.92
|
| Rate for Payer: Riverside University Health System MISP |
$4.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.92
|
| Rate for Payer: Vantage Medical Group Senior |
$8.92
|
|
|
HC BNDG PLASTER 6"
|
Facility
|
OP
|
$103.21
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605198
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$92.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.98
|
| Rate for Payer: Blue Distinction Transplant |
$61.93
|
| Rate for Payer: Blue Shield of California Commercial |
$64.92
|
| Rate for Payer: Blue Shield of California EPN |
$50.47
|
| Rate for Payer: Cash Price |
$46.44
|
| Rate for Payer: Cash Price |
$46.44
|
| Rate for Payer: Central Health Plan Commercial |
$82.57
|
| Rate for Payer: Cigna of CA HMO |
$66.05
|
| Rate for Payer: Cigna of CA PPO |
$76.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.73
|
| Rate for Payer: Dignity Health Media |
$87.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.28
|
| Rate for Payer: Galaxy Health WC |
$87.73
|
| Rate for Payer: Global Benefits Group Commercial |
$61.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.89
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$77.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$77.41
|
| Rate for Payer: Networks By Design Commercial |
$67.09
|
| Rate for Payer: Prime Health Services Commercial |
$87.73
|
| Rate for Payer: Riverside University Health System MISP |
$41.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.60
|
| Rate for Payer: United Healthcare All Other HMO |
$51.60
|
| Rate for Payer: United Healthcare HMO Rider |
$51.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.73
|
| Rate for Payer: Vantage Medical Group Senior |
$87.73
|
|
|
HC BNDG PLASTER 6"
|
Facility
|
IP
|
$103.21
|
|
|
Service Code
|
CPT A4580
|
| Hospital Charge Code |
901605198
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$92.89 |
| Rate for Payer: Cash Price |
$46.44
|
| Rate for Payer: Central Health Plan Commercial |
$82.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.28
|
| Rate for Payer: Galaxy Health WC |
$87.73
|
| Rate for Payer: Global Benefits Group Commercial |
$61.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$77.41
|
| Rate for Payer: Networks By Design Commercial |
$67.09
|
| Rate for Payer: Prime Health Services Commercial |
$87.73
|
|
|
HC BNDR ABD 12" 3 PANEL 30-45"
|
Facility
|
IP
|
$110.58
|
|
| Hospital Charge Code |
901607298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$99.52 |
| Rate for Payer: Cash Price |
$49.76
|
| Rate for Payer: Central Health Plan Commercial |
$88.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.23
|
| Rate for Payer: Galaxy Health WC |
$93.99
|
| Rate for Payer: Global Benefits Group Commercial |
$66.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.12
|
| Rate for Payer: Multiplan Commercial |
$82.94
|
| Rate for Payer: Networks By Design Commercial |
$71.88
|
| Rate for Payer: Prime Health Services Commercial |
$93.99
|
|
|
HC BNDR ABD 12" 3 PANEL 30-45"
|
Facility
|
OP
|
$110.58
|
|
| Hospital Charge Code |
901607298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$99.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.33
|
| Rate for Payer: Blue Distinction Transplant |
$66.35
|
| Rate for Payer: Blue Shield of California Commercial |
$69.55
|
| Rate for Payer: Blue Shield of California EPN |
$54.07
|
| Rate for Payer: Cash Price |
$49.76
|
| Rate for Payer: Central Health Plan Commercial |
$88.46
|
| Rate for Payer: Cigna of CA HMO |
$70.77
|
| Rate for Payer: Cigna of CA PPO |
$81.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.99
|
| Rate for Payer: Dignity Health Media |
$93.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.23
|
| Rate for Payer: Galaxy Health WC |
$93.99
|
| Rate for Payer: Global Benefits Group Commercial |
$66.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$82.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.12
|
| Rate for Payer: Multiplan Commercial |
$82.94
|
| Rate for Payer: Networks By Design Commercial |
$71.88
|
| Rate for Payer: Prime Health Services Commercial |
$93.99
|
| Rate for Payer: Riverside University Health System MISP |
$44.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.29
|
| Rate for Payer: United Healthcare All Other HMO |
$55.29
|
| Rate for Payer: United Healthcare HMO Rider |
$55.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.99
|
| Rate for Payer: Vantage Medical Group Senior |
$93.99
|
|
|
HC BNDR ABD 12" 3 PANEL 46-62"
|
Facility
|
IP
|
$113.39
|
|
| Hospital Charge Code |
901607299
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$102.05 |
| Rate for Payer: Cash Price |
$51.03
|
| Rate for Payer: Central Health Plan Commercial |
$90.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.36
|
| Rate for Payer: Galaxy Health WC |
$96.38
|
| Rate for Payer: Global Benefits Group Commercial |
$68.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.68
|
| Rate for Payer: Multiplan Commercial |
$85.04
|
| Rate for Payer: Networks By Design Commercial |
$73.70
|
| Rate for Payer: Prime Health Services Commercial |
$96.38
|
|
|
HC BNDR ABD 12" 3 PANEL 46-62"
|
Facility
|
OP
|
$113.39
|
|
| Hospital Charge Code |
901607299
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$102.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.99
|
| Rate for Payer: Blue Distinction Transplant |
$68.03
|
| Rate for Payer: Blue Shield of California Commercial |
$71.32
|
| Rate for Payer: Blue Shield of California EPN |
$55.45
|
| Rate for Payer: Cash Price |
$51.03
|
| Rate for Payer: Central Health Plan Commercial |
$90.71
|
| Rate for Payer: Cigna of CA HMO |
$72.57
|
| Rate for Payer: Cigna of CA PPO |
$83.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.38
|
| Rate for Payer: Dignity Health Media |
$96.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.36
|
| Rate for Payer: Galaxy Health WC |
$96.38
|
| Rate for Payer: Global Benefits Group Commercial |
$68.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$85.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.68
|
| Rate for Payer: Multiplan Commercial |
$85.04
|
| Rate for Payer: Networks By Design Commercial |
$73.70
|
| Rate for Payer: Prime Health Services Commercial |
$96.38
|
| Rate for Payer: Riverside University Health System MISP |
$45.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.70
|
| Rate for Payer: United Healthcare All Other HMO |
$56.70
|
| Rate for Payer: United Healthcare HMO Rider |
$56.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.38
|
| Rate for Payer: Vantage Medical Group Senior |
$96.38
|
|
|
HC BNDR ABD 12" 4 PANEL 30-45"
|
Facility
|
OP
|
$97.66
|
|
| Hospital Charge Code |
901607296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.70
|
| Rate for Payer: Blue Distinction Transplant |
$58.60
|
| Rate for Payer: Blue Shield of California Commercial |
$61.43
|
| Rate for Payer: Blue Shield of California EPN |
$47.76
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Central Health Plan Commercial |
$78.13
|
| Rate for Payer: Cigna of CA HMO |
$62.50
|
| Rate for Payer: Cigna of CA PPO |
$72.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.01
|
| Rate for Payer: Dignity Health Media |
$83.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$39.06
|
| Rate for Payer: Galaxy Health WC |
$83.01
|
| Rate for Payer: Global Benefits Group Commercial |
$58.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.89
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$73.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.53
|
| Rate for Payer: Multiplan Commercial |
$73.24
|
| Rate for Payer: Networks By Design Commercial |
$63.48
|
| Rate for Payer: Prime Health Services Commercial |
$83.01
|
| Rate for Payer: Riverside University Health System MISP |
$39.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.83
|
| Rate for Payer: United Healthcare All Other HMO |
$48.83
|
| Rate for Payer: United Healthcare HMO Rider |
$48.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.01
|
| Rate for Payer: Vantage Medical Group Senior |
$83.01
|
|
|
HC BNDR ABD 12" 4 PANEL 30-45"
|
Facility
|
IP
|
$97.66
|
|
| Hospital Charge Code |
901607296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Central Health Plan Commercial |
$78.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.06
|
| Rate for Payer: Galaxy Health WC |
$83.01
|
| Rate for Payer: Global Benefits Group Commercial |
$58.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.53
|
| Rate for Payer: Multiplan Commercial |
$73.24
|
| Rate for Payer: Networks By Design Commercial |
$63.48
|
| Rate for Payer: Prime Health Services Commercial |
$83.01
|
|
|
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: Cash Price |
$26.53
|
| Rate for Payer: Central Health Plan Commercial |
$47.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$39.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.46
|
| 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
|
|
