|
HC SKIN BARRIER 3ML SUREPREP WAND
|
Facility
|
OP
|
$12.96
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.32
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cigna of CA HMO |
$8.29
|
| Rate for Payer: Cigna of CA PPO |
$9.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Networks By Design Commercial |
$8.42
|
| Rate for Payer: Prime Health Services Commercial |
$11.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO |
$6.48
|
| Rate for Payer: United Healthcare HMO Rider |
$6.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.02
|
| Rate for Payer: Vantage Medical Group Senior |
$11.02
|
|
|
HC SKIN CLOSURE 1/2 X 4"
|
Facility
|
OP
|
$29.52
|
|
| Hospital Charge Code |
901605433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$25.09 |
| Rate for Payer: Adventist Health Commercial |
$5.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.94
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Cigna of CA HMO |
$18.89
|
| Rate for Payer: Cigna of CA PPO |
$21.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.81
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| Rate for Payer: Galaxy Health WC |
$25.09
|
| Rate for Payer: Global Benefits Group Commercial |
$17.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.66
|
| Rate for Payer: Multiplan Commercial |
$23.62
|
| Rate for Payer: Networks By Design Commercial |
$19.19
|
| Rate for Payer: Prime Health Services Commercial |
$25.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.76
|
| Rate for Payer: United Healthcare All Other HMO |
$14.76
|
| Rate for Payer: United Healthcare HMO Rider |
$14.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.09
|
| Rate for Payer: Vantage Medical Group Senior |
$25.09
|
|
|
HC SKIN CLOSURE 1/2 X 4"
|
Facility
|
IP
|
$29.52
|
|
| Hospital Charge Code |
901605433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$25.09 |
| Rate for Payer: Adventist Health Commercial |
$5.90
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.81
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| Rate for Payer: Galaxy Health WC |
$25.09
|
| Rate for Payer: Global Benefits Group Commercial |
$17.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.08
|
| Rate for Payer: Multiplan Commercial |
$23.62
|
| Rate for Payer: Networks By Design Commercial |
$19.19
|
| Rate for Payer: Prime Health Services Commercial |
$25.09
|
|
|
HC SKIN CLOSURE 1/4 X 3"
|
Facility
|
OP
|
$4.10
|
|
| Hospital Charge Code |
901605431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.63
|
| Rate for Payer: Cash Price |
$1.84
|
| 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: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| 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 Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC SKIN CLOSURE 1/4 X 3"
|
Facility
|
IP
|
$4.10
|
|
| Hospital Charge Code |
901605431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC SKIN CLOSURE 1/4 X 4"
|
Facility
|
OP
|
$29.77
|
|
| Hospital Charge Code |
901605432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.10
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cigna of CA HMO |
$19.05
|
| Rate for Payer: Cigna of CA PPO |
$22.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.84
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
|
|
HC SKIN CLOSURE 1/4 X 4"
|
Facility
|
IP
|
$29.77
|
|
| Hospital Charge Code |
901605432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
|
|
HC SKIN CLOSURE 1/8 X 3"
|
Facility
|
OP
|
$4.43
|
|
| Hospital Charge Code |
901605430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.84
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cigna of CA HMO |
$2.84
|
| Rate for Payer: Cigna of CA PPO |
$3.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$3.54
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.77
|
| Rate for Payer: Vantage Medical Group Senior |
$3.77
|
|
|
HC SKIN CLOSURE 1/8 X 3"
|
Facility
|
IP
|
$4.43
|
|
| Hospital Charge Code |
901605430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.54
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
|
|
HC SKIN CLOSURE 1 X 4"
|
Facility
|
IP
|
$124.87
|
|
| Hospital Charge Code |
901605434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$106.14 |
| Rate for Payer: Adventist Health Commercial |
$24.97
|
| Rate for Payer: Cash Price |
$56.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.95
|
| Rate for Payer: EPIC Health Plan Senior |
$49.95
|
| Rate for Payer: Galaxy Health WC |
$106.14
|
| Rate for Payer: Global Benefits Group Commercial |
$74.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.97
|
| Rate for Payer: Multiplan Commercial |
$99.90
|
| Rate for Payer: Networks By Design Commercial |
$81.17
|
| Rate for Payer: Prime Health Services Commercial |
$106.14
|
|
|
HC SKIN CLOSURE 1 X 4"
|
Facility
|
OP
|
$124.87
|
|
| Hospital Charge Code |
901605434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$106.14 |
| Rate for Payer: Adventist Health Commercial |
$24.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.13
|
| Rate for Payer: Cash Price |
$56.19
|
| Rate for Payer: Cigna of CA HMO |
$79.92
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.95
|
| Rate for Payer: EPIC Health Plan Senior |
$49.95
|
| Rate for Payer: Galaxy Health WC |
$106.14
|
| Rate for Payer: Global Benefits Group Commercial |
$74.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.41
|
| Rate for Payer: Multiplan Commercial |
$99.90
|
| Rate for Payer: Networks By Design Commercial |
$81.17
|
| Rate for Payer: Prime Health Services Commercial |
$106.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.44
|
| Rate for Payer: United Healthcare All Other HMO |
$62.44
|
| Rate for Payer: United Healthcare HMO Rider |
$62.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.14
|
| Rate for Payer: Vantage Medical Group Senior |
$106.14
|
|
|
HC SKIN CLOSURES 1" X 5"
|
Facility
|
OP
|
$21.40
|
|
| Hospital Charge Code |
901604398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: Cigna of CA PPO |
$15.84
|
| Rate for Payer: Adventist Health Commercial |
$4.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.73
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.56
|
| Rate for Payer: EPIC Health Plan Senior |
$8.56
|
| Rate for Payer: Galaxy Health WC |
$18.19
|
| Rate for Payer: Global Benefits Group Commercial |
$12.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.98
|
| Rate for Payer: Multiplan Commercial |
$17.12
|
| Rate for Payer: Networks By Design Commercial |
$13.91
|
| Rate for Payer: Prime Health Services Commercial |
$18.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.70
|
| Rate for Payer: United Healthcare All Other HMO |
$10.70
|
| Rate for Payer: United Healthcare HMO Rider |
$10.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.19
|
| Rate for Payer: Vantage Medical Group Senior |
$18.19
|
|
|
HC SKIN CLOSURES 1" X 5"
|
Facility
|
IP
|
$21.40
|
|
| Hospital Charge Code |
901604398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: Adventist Health Commercial |
$4.28
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.56
|
| Rate for Payer: EPIC Health Plan Senior |
$8.56
|
| Rate for Payer: Galaxy Health WC |
$18.19
|
| Rate for Payer: Global Benefits Group Commercial |
$12.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$17.12
|
| Rate for Payer: Networks By Design Commercial |
$13.91
|
| Rate for Payer: Prime Health Services Commercial |
$18.19
|
|
|
HC SKIN PRO PASTE PHYTOPLEX 2 OZ
|
Facility
|
OP
|
$20.25
|
|
| Hospital Charge Code |
901698704
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.99
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cigna of CA HMO |
$12.96
|
| Rate for Payer: Cigna of CA PPO |
$14.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.12
|
| Rate for Payer: United Healthcare All Other HMO |
$10.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.21
|
| Rate for Payer: Vantage Medical Group Senior |
$17.21
|
|
|
HC SKIN PRO PASTE PHYTOPLEX 2 OZ
|
Facility
|
IP
|
$20.25
|
|
| Hospital Charge Code |
901698704
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
|
|
HC SKIN PROTECTANT CAVILON 0.7ML
|
Facility
|
IP
|
$45.92
|
|
| Hospital Charge Code |
901698453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$39.03 |
| Rate for Payer: Adventist Health Commercial |
$9.18
|
| Rate for Payer: Cash Price |
$20.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$39.03
|
| Rate for Payer: Global Benefits Group Commercial |
$27.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$36.74
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.03
|
|
|
HC SKIN PROTECTANT CAVILON 0.7ML
|
Facility
|
OP
|
$45.92
|
|
| Hospital Charge Code |
901698453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$39.03 |
| Rate for Payer: Adventist Health Commercial |
$9.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.47
|
| Rate for Payer: Cash Price |
$20.66
|
| Rate for Payer: Cigna of CA HMO |
$29.39
|
| Rate for Payer: Cigna of CA PPO |
$33.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$39.03
|
| Rate for Payer: Global Benefits Group Commercial |
$27.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.14
|
| Rate for Payer: Multiplan Commercial |
$36.74
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.96
|
| Rate for Payer: United Healthcare All Other HMO |
$22.96
|
| Rate for Payer: United Healthcare HMO Rider |
$22.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.03
|
| Rate for Payer: Vantage Medical Group Senior |
$39.03
|
|
|
HC SKIN PROTECTNT REMEDY 2OZ PSTE
|
Facility
|
OP
|
$29.60
|
|
| Hospital Charge Code |
901698680
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$25.16 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.16
|
| Rate for Payer: Vantage Medical Group Senior |
$25.16
|
| Rate for Payer: Adventist Health Commercial |
$5.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.99
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cigna of CA HMO |
$18.94
|
| Rate for Payer: Cigna of CA PPO |
$21.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.84
|
| Rate for Payer: EPIC Health Plan Senior |
$11.84
|
| Rate for Payer: Galaxy Health WC |
$25.16
|
| Rate for Payer: Global Benefits Group Commercial |
$17.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.72
|
| Rate for Payer: Multiplan Commercial |
$23.68
|
| Rate for Payer: Networks By Design Commercial |
$19.24
|
| Rate for Payer: Prime Health Services Commercial |
$25.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.80
|
| Rate for Payer: United Healthcare All Other HMO |
$14.80
|
| Rate for Payer: United Healthcare HMO Rider |
$14.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.16
|
|
|
HC SKIN PROTECTNT REMEDY 2OZ PSTE
|
Facility
|
IP
|
$29.60
|
|
| Hospital Charge Code |
901698680
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$25.16 |
| Rate for Payer: Adventist Health Commercial |
$5.92
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.84
|
| Rate for Payer: EPIC Health Plan Senior |
$11.84
|
| Rate for Payer: Galaxy Health WC |
$25.16
|
| Rate for Payer: Global Benefits Group Commercial |
$17.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.10
|
| Rate for Payer: Multiplan Commercial |
$23.68
|
| Rate for Payer: Networks By Design Commercial |
$19.24
|
| Rate for Payer: Prime Health Services Commercial |
$25.16
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
OP
|
$2,197.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.74 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$1,867.45
|
| Rate for Payer: Adventist Health Commercial |
$439.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$988.65
|
| Rate for Payer: Cash Price |
$988.65
|
| Rate for Payer: Cash Price |
$988.65
|
| Rate for Payer: Cigna of CA HMO |
$1,406.08
|
| Rate for Payer: Cigna of CA PPO |
$1,625.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,537.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,395.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$1,757.60
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$1,428.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,867.45
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,318.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,098.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,098.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,098.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,098.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
IP
|
$2,197.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.40 |
| Max. Negotiated Rate |
$1,867.45 |
| Rate for Payer: Adventist Health Commercial |
$439.40
|
| Rate for Payer: Cash Price |
$988.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,537.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$878.80
|
| Rate for Payer: EPIC Health Plan Senior |
$878.80
|
| Rate for Payer: Galaxy Health WC |
$1,867.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,395.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,296.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.28
|
| Rate for Payer: Multiplan Commercial |
$1,757.60
|
| Rate for Payer: Networks By Design Commercial |
$1,428.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,867.45
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET 1ST 100 SQ CM
|
Facility
|
OP
|
$7,155.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
900101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.71 |
| Max. Negotiated Rate |
$6,081.75 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,287.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Cigna of CA HMO |
$4,579.20
|
| Rate for Payer: Cigna of CA PPO |
$5,294.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,008.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$297.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,543.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,343.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$5,724.00
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,293.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,293.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,577.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,577.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,577.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,577.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET 1ST 100 SQ CM
|
Facility
|
IP
|
$7,155.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
900101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,431.00 |
| Max. Negotiated Rate |
$6,081.75 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,008.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,862.00
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,543.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,221.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.20
|
| Rate for Payer: Multiplan Commercial |
$5,724.00
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
|
|
HC SKULL COMPLETE
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$936.70 |
| Rate for Payer: Adventist Health Commercial |
$220.40
|
| Rate for Payer: Cash Price |
$495.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$771.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Senior |
$440.80
|
| Rate for Payer: Galaxy Health WC |
$936.70
|
| Rate for Payer: Global Benefits Group Commercial |
$661.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$699.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$650.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.48
|
| Rate for Payer: Multiplan Commercial |
$881.60
|
| Rate for Payer: Networks By Design Commercial |
$716.30
|
| Rate for Payer: Prime Health Services Commercial |
$936.70
|
|
|
HC SKULL COMPLETE
|
Facility
|
OP
|
$1,102.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.57 |
| Max. Negotiated Rate |
$936.70 |
| Rate for Payer: Adventist Health Commercial |
$220.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.24
|
| Rate for Payer: Blue Shield of California Commercial |
$463.94
|
| Rate for Payer: Blue Shield of California Commercial |
$703.08
|
| Rate for Payer: Cash Price |
$495.90
|
| Rate for Payer: Cash Price |
$495.90
|
| Rate for Payer: Cigna of CA HMO |
$705.28
|
| Rate for Payer: Cigna of CA PPO |
$815.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$771.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$936.70
|
| Rate for Payer: Global Benefits Group Commercial |
$661.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$699.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$881.60
|
| Rate for Payer: Networks By Design Commercial |
$716.30
|
| Rate for Payer: Prime Health Services Commercial |
$936.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$661.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$661.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
