|
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 |
$537.90
|
| Rate for Payer: Cash Price |
$537.90
|
| Rate for Payer: Cash Price |
$537.90
|
| 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 |
$537.90
|
| 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
|
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 |
$352.55
|
| 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 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 |
$352.55
|
| Rate for Payer: Cash Price |
$352.55
|
| Rate for Payer: Cash Price |
$352.55
|
| 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 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 |
$26.43
|
| 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 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 |
$26.43
|
| 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 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 |
$60.19
|
| 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
|
|
|
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 |
$60.19
|
| 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 8X12"
|
Facility
|
OP
|
$162.61
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901698257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$138.22 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.86
|
| Rate for Payer: Cash Price |
$89.44
|
| Rate for Payer: Cigna of CA HMO |
$104.07
|
| Rate for Payer: Cigna of CA PPO |
$120.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.83
|
| Rate for Payer: Multiplan Commercial |
$130.09
|
| Rate for Payer: Networks By Design Commercial |
$105.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.31
|
| Rate for Payer: United Healthcare All Other HMO |
$81.31
|
| Rate for Payer: United Healthcare HMO Rider |
$81.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.22
|
| Rate for Payer: Vantage Medical Group Senior |
$138.22
|
|
|
HC DRESSING EXUFIBER AG 8X12"
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901698257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$138.22 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Cash Price |
$89.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.03
|
| Rate for Payer: Multiplan Commercial |
$130.09
|
| Rate for Payer: Networks By Design Commercial |
$105.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
|
|
HC DRESSING HYDROFERA FOAM 8X8"
|
Facility
|
OP
|
$116.74
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$99.23 |
| Rate for Payer: Adventist Health Commercial |
$23.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.69
|
| Rate for Payer: Cash Price |
$64.21
|
| Rate for Payer: Cigna of CA HMO |
$74.71
|
| Rate for Payer: Cigna of CA PPO |
$86.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$99.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.70
|
| Rate for Payer: EPIC Health Plan Senior |
$46.70
|
| Rate for Payer: Galaxy Health WC |
$99.23
|
| Rate for Payer: Global Benefits Group Commercial |
$70.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.72
|
| Rate for Payer: Multiplan Commercial |
$93.39
|
| Rate for Payer: Networks By Design Commercial |
$75.88
|
| Rate for Payer: Prime Health Services Commercial |
$99.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.37
|
| Rate for Payer: United Healthcare All Other HMO |
$58.37
|
| Rate for Payer: United Healthcare HMO Rider |
$58.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.23
|
| Rate for Payer: Vantage Medical Group Senior |
$99.23
|
|
|
HC DRESSING HYDROFERA FOAM 8X8"
|
Facility
|
IP
|
$116.74
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$99.23 |
| Rate for Payer: Adventist Health Commercial |
$23.35
|
| Rate for Payer: Cash Price |
$64.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.70
|
| Rate for Payer: EPIC Health Plan Senior |
$46.70
|
| Rate for Payer: Galaxy Health WC |
$99.23
|
| Rate for Payer: Global Benefits Group Commercial |
$70.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.02
|
| Rate for Payer: Multiplan Commercial |
$93.39
|
| Rate for Payer: Networks By Design Commercial |
$75.88
|
| Rate for Payer: Prime Health Services Commercial |
$99.23
|
|
|
HC DRESSING MEPITEL ONE 2X3"
|
Facility
|
IP
|
$24.03
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901607884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$20.43 |
| Rate for Payer: Adventist Health Commercial |
$4.81
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.61
|
| Rate for Payer: EPIC Health Plan Senior |
$9.61
|
| Rate for Payer: Galaxy Health WC |
$20.43
|
| Rate for Payer: Global Benefits Group Commercial |
$14.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$19.22
|
| Rate for Payer: Networks By Design Commercial |
$15.62
|
| Rate for Payer: Prime Health Services Commercial |
$20.43
|
|
|
HC DRESSING MEPITEL ONE 2X3"
|
Facility
|
OP
|
$24.03
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901607884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$20.43 |
| Rate for Payer: Adventist Health Commercial |
$4.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.76
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cigna of CA HMO |
$15.38
|
| Rate for Payer: Cigna of CA PPO |
$17.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.61
|
| Rate for Payer: EPIC Health Plan Senior |
$9.61
|
| Rate for Payer: Galaxy Health WC |
$20.43
|
| Rate for Payer: Global Benefits Group Commercial |
$14.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.82
|
| Rate for Payer: Multiplan Commercial |
$19.22
|
| Rate for Payer: Networks By Design Commercial |
$15.62
|
| Rate for Payer: Prime Health Services Commercial |
$20.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.02
|
| Rate for Payer: United Healthcare All Other HMO |
$12.02
|
| Rate for Payer: United Healthcare HMO Rider |
$12.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.43
|
| Rate for Payer: Vantage Medical Group Senior |
$20.43
|
|
|
HC DRESSING SACRUM OPTIFOAM 9X9
|
Facility
|
OP
|
$76.42
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$64.96 |
| Rate for Payer: Adventist Health Commercial |
$15.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.93
|
| Rate for Payer: Cash Price |
$42.03
|
| Rate for Payer: Cigna of CA HMO |
$48.91
|
| Rate for Payer: Cigna of CA PPO |
$56.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.57
|
| Rate for Payer: EPIC Health Plan Senior |
$30.57
|
| Rate for Payer: Galaxy Health WC |
$64.96
|
| Rate for Payer: Global Benefits Group Commercial |
$45.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.49
|
| Rate for Payer: Multiplan Commercial |
$61.14
|
| Rate for Payer: Networks By Design Commercial |
$49.67
|
| Rate for Payer: Prime Health Services Commercial |
$64.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.21
|
| Rate for Payer: United Healthcare All Other HMO |
$38.21
|
| Rate for Payer: United Healthcare HMO Rider |
$38.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.96
|
| Rate for Payer: Vantage Medical Group Senior |
$64.96
|
|
|
HC DRESSING SACRUM OPTIFOAM 9X9
|
Facility
|
IP
|
$76.42
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$64.96 |
| Rate for Payer: Adventist Health Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$42.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.57
|
| Rate for Payer: EPIC Health Plan Senior |
$30.57
|
| Rate for Payer: Galaxy Health WC |
$64.96
|
| Rate for Payer: Global Benefits Group Commercial |
$45.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.34
|
| Rate for Payer: Multiplan Commercial |
$61.14
|
| Rate for Payer: Networks By Design Commercial |
$49.67
|
| Rate for Payer: Prime Health Services Commercial |
$64.96
|
|
|
HC DRES TEGADERM 8X6" TRANSPARENT FRAME STYLE
|
Facility
|
IP
|
$9.92
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901605554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.43 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: EPIC Health Plan Senior |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$8.43
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$7.94
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$8.43
|
|
|
HC DRES TEGADERM 8X6" TRANSPARENT FRAME STYLE
|
Facility
|
OP
|
$9.92
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901605554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.43 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.09
|
| Rate for Payer: Cash Price |
$5.46
|
| Rate for Payer: Cigna of CA HMO |
$6.35
|
| Rate for Payer: Cigna of CA PPO |
$7.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: EPIC Health Plan Senior |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$8.43
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$7.94
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$8.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.43
|
| Rate for Payer: Vantage Medical Group Senior |
$8.43
|
|
|
HC DRES THERAHONEY 1.5 OZ TUBE
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698131
|
|
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 |
$45.10
|
| 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 DRES THERAHONEY 1.5 OZ TUBE
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698131
|
|
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 |
$45.10
|
| 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 DRIED BLOOD SPOT SCREEN DUKE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.09
|
| Rate for Payer: Blue Shield of California Commercial |
$97.00
|
| Rate for Payer: Blue Shield of California EPN |
$64.09
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cigna of CA HMO |
$92.80
|
| Rate for Payer: Cigna of CA PPO |
$107.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC DRIED BLOOD SPOT SCREEN DUKE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
|
|
HC DRILL SKULL FOR IMPLANTATION
|
Facility
|
OP
|
$5,806.00
|
|
|
Service Code
|
CPT 61107
|
| Hospital Charge Code |
900501647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$525.39 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,161.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,935.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,193.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,354.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,193.30
|
| Rate for Payer: Cash Price |
$3,193.30
|
| Rate for Payer: Cash Price |
$3,193.30
|
| Rate for Payer: Cigna of CA HMO |
$3,715.84
|
| Rate for Payer: Cigna of CA PPO |
$4,296.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,935.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,935.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,935.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,322.40
|
| Rate for Payer: Galaxy Health WC |
$4,935.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,483.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$525.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,872.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,593.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,064.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,064.20
|
| Rate for Payer: Multiplan Commercial |
$4,644.80
|
| Rate for Payer: Networks By Design Commercial |
$3,773.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,935.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,483.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,935.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,935.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,935.10
|
|
|
HC DRILL SKULL FOR IMPLANTATION
|
Facility
|
IP
|
$5,806.00
|
|
|
Service Code
|
CPT 61107
|
| Hospital Charge Code |
900501647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,161.20 |
| Max. Negotiated Rate |
$4,935.10 |
| Rate for Payer: Adventist Health Commercial |
$1,161.20
|
| Rate for Payer: Cash Price |
$3,193.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,322.40
|
| Rate for Payer: Galaxy Health WC |
$4,935.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,483.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,872.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,212.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,593.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,393.44
|
| Rate for Payer: Multiplan Commercial |
$4,644.80
|
| Rate for Payer: Networks By Design Commercial |
$3,773.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,935.10
|
|
|
HC DROP LOCK RETAINER PER BAR
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
915352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
|
