|
HC DRAIN ROUND 15FR W/TROCAR
|
Facility
|
OP
|
$184.73
|
|
| Hospital Charge Code |
901698884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$157.02 |
| Rate for Payer: Adventist Health Commercial |
$36.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.44
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Cigna of CA HMO |
$118.23
|
| Rate for Payer: Cigna of CA PPO |
$136.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.89
|
| Rate for Payer: EPIC Health Plan Senior |
$73.89
|
| Rate for Payer: Galaxy Health WC |
$157.02
|
| Rate for Payer: Global Benefits Group Commercial |
$110.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$129.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$129.31
|
| Rate for Payer: Multiplan Commercial |
$147.78
|
| Rate for Payer: Networks By Design Commercial |
$120.07
|
| Rate for Payer: Prime Health Services Commercial |
$157.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.36
|
| Rate for Payer: United Healthcare All Other HMO |
$92.36
|
| Rate for Payer: United Healthcare HMO Rider |
$92.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.02
|
| Rate for Payer: Vantage Medical Group Senior |
$157.02
|
|
|
HC DRAIN ROUND 19FR W/TROCAR
|
Facility
|
IP
|
$192.29
|
|
| Hospital Charge Code |
901603855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.46 |
| Max. Negotiated Rate |
$163.45 |
| Rate for Payer: Adventist Health Commercial |
$38.46
|
| Rate for Payer: Cash Price |
$86.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.92
|
| Rate for Payer: EPIC Health Plan Senior |
$76.92
|
| Rate for Payer: Galaxy Health WC |
$163.45
|
| Rate for Payer: Global Benefits Group Commercial |
$115.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.15
|
| Rate for Payer: Multiplan Commercial |
$153.83
|
| Rate for Payer: Networks By Design Commercial |
$124.99
|
| Rate for Payer: Prime Health Services Commercial |
$163.45
|
|
|
HC DRAIN ROUND 19FR W/TROCAR
|
Facility
|
OP
|
$192.29
|
|
| Hospital Charge Code |
901603855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.46 |
| Max. Negotiated Rate |
$163.45 |
| Rate for Payer: Adventist Health Commercial |
$38.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.09
|
| Rate for Payer: Cash Price |
$86.53
|
| Rate for Payer: Cigna of CA HMO |
$123.07
|
| Rate for Payer: Cigna of CA PPO |
$142.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.92
|
| Rate for Payer: EPIC Health Plan Senior |
$76.92
|
| Rate for Payer: Galaxy Health WC |
$163.45
|
| Rate for Payer: Global Benefits Group Commercial |
$115.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.60
|
| Rate for Payer: Multiplan Commercial |
$153.83
|
| Rate for Payer: Networks By Design Commercial |
$124.99
|
| Rate for Payer: Prime Health Services Commercial |
$163.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.14
|
| Rate for Payer: United Healthcare All Other HMO |
$96.14
|
| Rate for Payer: United Healthcare HMO Rider |
$96.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.45
|
| Rate for Payer: Vantage Medical Group Senior |
$163.45
|
|
|
HC DRAIN SPONGE EXCILON 4X4" STE
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
CPT A6402
|
| Hospital Charge Code |
901698578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
HC DRAIN SPONGE EXCILON 4X4" STE
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
CPT A6402
|
| Hospital Charge Code |
901698578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.35
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$0.46
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
HC DRAIN WOUND 1/8"
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901605791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC DRAIN WOUND 1/8"
|
Facility
|
IP
|
$74.78
|
|
| Hospital Charge Code |
901692010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$63.56 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: Multiplan Commercial |
$59.82
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
|
|
HC DRAIN WOUND 1/8"
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901605791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$36.90
|
| 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: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| 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 Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRAIN WOUND 1/8"
|
Facility
|
OP
|
$74.78
|
|
| Hospital Charge Code |
901692010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$63.56 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.92
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Cigna of CA HMO |
$47.86
|
| Rate for Payer: Cigna of CA PPO |
$55.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.35
|
| Rate for Payer: Multiplan Commercial |
$59.82
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.39
|
| Rate for Payer: United Healthcare All Other HMO |
$37.39
|
| Rate for Payer: United Healthcare HMO Rider |
$37.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.56
|
| Rate for Payer: Vantage Medical Group Senior |
$63.56
|
|
|
HC DRES AQUACEL AG 4IN X 5IN
|
Facility
|
OP
|
$71.91
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$61.12 |
| Rate for Payer: Adventist Health Commercial |
$14.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.16
|
| Rate for Payer: Cash Price |
$32.36
|
| Rate for Payer: Cigna of CA HMO |
$46.02
|
| Rate for Payer: Cigna of CA PPO |
$53.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.76
|
| Rate for Payer: EPIC Health Plan Senior |
$28.76
|
| Rate for Payer: Galaxy Health WC |
$61.12
|
| Rate for Payer: Global Benefits Group Commercial |
$43.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.34
|
| Rate for Payer: Multiplan Commercial |
$57.53
|
| Rate for Payer: Networks By Design Commercial |
$46.74
|
| Rate for Payer: Prime Health Services Commercial |
$61.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.95
|
| Rate for Payer: United Healthcare All Other HMO |
$35.95
|
| Rate for Payer: United Healthcare HMO Rider |
$35.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.12
|
| Rate for Payer: Vantage Medical Group Senior |
$61.12
|
|
|
HC DRES AQUACEL AG 4IN X 5IN
|
Facility
|
IP
|
$71.91
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$61.12 |
| Rate for Payer: Adventist Health Commercial |
$14.38
|
| Rate for Payer: Cash Price |
$32.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.76
|
| Rate for Payer: EPIC Health Plan Senior |
$28.76
|
| Rate for Payer: Galaxy Health WC |
$61.12
|
| Rate for Payer: Global Benefits Group Commercial |
$43.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$57.53
|
| Rate for Payer: Networks By Design Commercial |
$46.74
|
| Rate for Payer: Prime Health Services Commercial |
$61.12
|
|
|
HC DRES HYDROGEL 4X4 CLEAR CARRADRES
|
Facility
|
OP
|
$24.85
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.26
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cigna of CA HMO |
$15.90
|
| Rate for Payer: Cigna of CA PPO |
$18.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Senior |
$9.94
|
| Rate for Payer: Galaxy Health WC |
$21.12
|
| Rate for Payer: Global Benefits Group Commercial |
$14.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$19.88
|
| Rate for Payer: Networks By Design Commercial |
$16.15
|
| Rate for Payer: Prime Health Services Commercial |
$21.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.43
|
| Rate for Payer: United Healthcare All Other HMO |
$12.43
|
| Rate for Payer: United Healthcare HMO Rider |
$12.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.12
|
| Rate for Payer: Vantage Medical Group Senior |
$21.12
|
|
|
HC DRES HYDROGEL 4X4 CLEAR CARRADRES
|
Facility
|
IP
|
$24.85
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$21.12 |
| Rate for Payer: Adventist Health Commercial |
$4.97
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.94
|
| Rate for Payer: EPIC Health Plan Senior |
$9.94
|
| Rate for Payer: Galaxy Health WC |
$21.12
|
| Rate for Payer: Global Benefits Group Commercial |
$14.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Multiplan Commercial |
$19.88
|
| Rate for Payer: Networks By Design Commercial |
$16.15
|
| Rate for Payer: Prime Health Services Commercial |
$21.12
|
|
|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
IP
|
$1,648.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.60 |
| Max. Negotiated Rate |
$1,400.80 |
| Rate for Payer: Adventist Health Commercial |
$329.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.20
|
| Rate for Payer: EPIC Health Plan Senior |
$659.20
|
| Rate for Payer: Galaxy Health WC |
$1,400.80
|
| Rate for Payer: Global Benefits Group Commercial |
$988.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,020.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.52
|
| Rate for Payer: Multiplan Commercial |
$1,318.40
|
| Rate for Payer: Networks By Design Commercial |
$1,071.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,400.80
|
|
|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
OP
|
$1,648.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.60 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$329.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cigna of CA HMO |
$1,054.72
|
| Rate for Payer: Cigna of CA PPO |
$1,219.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,400.80
|
| Rate for Payer: Global Benefits Group Commercial |
$988.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,318.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,071.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,400.80
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$824.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$824.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$824.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC DRES & OR DEB OF BURN INT/SUB MED
|
Facility
|
IP
|
$1,386.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$1,178.10 |
| Rate for Payer: Adventist Health Commercial |
$277.20
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$554.40
|
| Rate for Payer: EPIC Health Plan Senior |
$554.40
|
| Rate for Payer: Galaxy Health WC |
$1,178.10
|
| Rate for Payer: Global Benefits Group Commercial |
$831.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$924.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$857.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.64
|
| Rate for Payer: Multiplan Commercial |
$1,108.80
|
| Rate for Payer: Networks By Design Commercial |
$900.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,178.10
|
|
|
HC DRES & OR DEB OF BURN INT/SUB MED
|
Facility
|
OP
|
$1,386.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$277.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cash Price |
$623.70
|
| Rate for Payer: Cigna of CA HMO |
$887.04
|
| Rate for Payer: Cigna of CA PPO |
$1,025.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,178.10
|
| Rate for Payer: Global Benefits Group Commercial |
$831.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$924.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,108.80
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$900.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,178.10
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$831.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$693.00
|
| Rate for Payer: United Healthcare All Other HMO |
$693.00
|
| Rate for Payer: United Healthcare HMO Rider |
$693.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$693.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC DRES & OR DEB OF BURN INT/SUB SMALL
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
900501046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$195.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna of CA HMO |
$625.92
|
| Rate for Payer: Cigna of CA PPO |
$723.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$831.30
|
| Rate for Payer: Global Benefits Group Commercial |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$782.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$635.70
|
| Rate for Payer: Prime Health Services Commercial |
$831.30
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$489.00
|
| Rate for Payer: United Healthcare All Other HMO |
$489.00
|
| Rate for Payer: United Healthcare HMO Rider |
$489.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$489.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC DRES & OR DEB OF BURN INT/SUB SMALL
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
900501046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$831.30 |
| Rate for Payer: Adventist Health Commercial |
$195.60
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.20
|
| Rate for Payer: EPIC Health Plan Senior |
$391.20
|
| Rate for Payer: Galaxy Health WC |
$831.30
|
| Rate for Payer: Global Benefits Group Commercial |
$586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$605.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.72
|
| Rate for Payer: Multiplan Commercial |
$782.40
|
| Rate for Payer: Networks By Design Commercial |
$635.70
|
| Rate for Payer: Prime Health Services Commercial |
$831.30
|
|
|
HC DRESSING CHANGE UNDER ANESTH
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cigna of CA HMO |
$410.24
|
| Rate for Payer: Cigna of CA PPO |
$474.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$512.80
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$416.65
|
| Rate for Payer: Prime Health Services Commercial |
$544.85
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$320.50
|
| Rate for Payer: United Healthcare All Other HMO |
$320.50
|
| Rate for Payer: United Healthcare HMO Rider |
$320.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$320.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC DRESSING CHANGE UNDER ANESTH
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$544.85 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.40
|
| Rate for Payer: EPIC Health Plan Senior |
$256.40
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$396.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.84
|
| Rate for Payer: Multiplan Commercial |
$512.80
|
| Rate for Payer: Networks By Design Commercial |
$416.65
|
| Rate for Payer: Prime Health Services Commercial |
$544.85
|
|
|
HC DRESSING EXUFIBER 6X6"
|
Facility
|
IP
|
$48.05
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$40.84 |
| Rate for Payer: Adventist Health Commercial |
$9.61
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.22
|
| Rate for Payer: EPIC Health Plan Senior |
$19.22
|
| Rate for Payer: Galaxy Health WC |
$40.84
|
| Rate for Payer: Global Benefits Group Commercial |
$28.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$38.44
|
| Rate for Payer: Networks By Design Commercial |
$31.23
|
| Rate for Payer: Prime Health Services Commercial |
$40.84
|
|
|
HC DRESSING EXUFIBER 6X6"
|
Facility
|
OP
|
$48.05
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$40.84 |
| Rate for Payer: Adventist Health Commercial |
$9.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.51
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cigna of CA HMO |
$30.75
|
| Rate for Payer: Cigna of CA PPO |
$35.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.22
|
| Rate for Payer: EPIC Health Plan Senior |
$19.22
|
| Rate for Payer: Galaxy Health WC |
$40.84
|
| Rate for Payer: Global Benefits Group Commercial |
$28.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.63
|
| Rate for Payer: Multiplan Commercial |
$38.44
|
| Rate for Payer: Networks By Design Commercial |
$31.23
|
| Rate for Payer: Prime Health Services Commercial |
$40.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.02
|
| Rate for Payer: United Healthcare All Other HMO |
$24.02
|
| Rate for Payer: United Healthcare HMO Rider |
$24.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.84
|
| Rate for Payer: Vantage Medical Group Senior |
$40.84
|
|
|
HC DRESSING EXUFIBER AG 6X6"
|
Facility
|
IP
|
$109.44
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$93.02 |
| Rate for Payer: Adventist Health Commercial |
$21.89
|
| Rate for Payer: Cash Price |
$49.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.78
|
| Rate for Payer: EPIC Health Plan Senior |
$43.78
|
| Rate for Payer: Galaxy Health WC |
$93.02
|
| Rate for Payer: Global Benefits Group Commercial |
$65.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.27
|
| Rate for Payer: Multiplan Commercial |
$87.55
|
| Rate for Payer: Networks By Design Commercial |
$71.14
|
| Rate for Payer: Prime Health Services Commercial |
$93.02
|
|
|
HC DRESSING EXUFIBER AG 6X6"
|
Facility
|
OP
|
$109.44
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$93.02 |
| Rate for Payer: Adventist Health Commercial |
$21.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.21
|
| Rate for Payer: Cash Price |
$49.25
|
| Rate for Payer: Cigna of CA HMO |
$70.04
|
| Rate for Payer: Cigna of CA PPO |
$80.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.78
|
| Rate for Payer: EPIC Health Plan Senior |
$43.78
|
| Rate for Payer: Galaxy Health WC |
$93.02
|
| Rate for Payer: Global Benefits Group Commercial |
$65.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.61
|
| Rate for Payer: Multiplan Commercial |
$87.55
|
| Rate for Payer: Networks By Design Commercial |
$71.14
|
| Rate for Payer: Prime Health Services Commercial |
$93.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Other HMO |
$54.72
|
| Rate for Payer: United Healthcare HMO Rider |
$54.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.02
|
| Rate for Payer: Vantage Medical Group Senior |
$93.02
|
|
