|
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 |
$123.39
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$122.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.45
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$122.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.45
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| 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 |
$0.35
|
| 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 |
$0.37
|
| Rate for Payer: Cash Price |
$0.26
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| 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
|
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 |
$52.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| 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 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 |
$46.86
|
| 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 |
$46.14
|
| Rate for Payer: Cash Price |
$32.36
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.34
|
| 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 Foundation Hospitals Commercial/Self Funded |
$45.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.43
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.34
|
| 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 Foundation Hospitals Commercial/Self Funded |
$45.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.43
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.39
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.66
|
| 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 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 |
$13.35
|
| 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 |
$15.95
|
| Rate for Payer: Cash Price |
$11.18
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.39
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.66
|
| 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 & OR DEB OF BURN INT/SUB LG
|
Facility
|
IP
|
$1,648.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,153.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,046.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$972.32
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$329.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,153.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| 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/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,046.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| 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 |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
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
|
456
|
| Min. Negotiated Rate |
$395.52 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$675.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$810.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,153.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| 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/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,046.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| 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: TriValley Medical Group Commercial/Senior |
$988.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,153.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,046.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$972.32
|
| 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 MED
|
Facility
|
IP
|
$1,386.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$970.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$880.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$817.74
|
| 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
|
456
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$568.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$970.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| 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/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$880.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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: TriValley Medical Group Commercial/Senior |
$831.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$970.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$880.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$817.74
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$277.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$970.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| 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/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$880.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DRES & OR DEB OF BURN INT/SUB SMALL
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
900501046
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$684.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$621.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$577.02
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$684.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$621.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$577.02
|
| 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 DRES & OR DEB OF BURN INT/SUB SMALL
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
900501046
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$400.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$357.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$684.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$831.30
|
| Rate for Payer: Global Benefits Group Commercial |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$621.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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: TriValley Medical Group Commercial/Senior |
$586.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
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 |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$831.30
|
| Rate for Payer: Global Benefits Group Commercial |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$621.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
| Rate for Payer: Adventist Health Commercial |
$195.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$684.60
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| 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 |
$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 |
$1,425.86
|
| 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 |
$448.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| 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 |
$407.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$232.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.84
|
| 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 |
$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 |
$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 DRESSING CHANGE UNDER ANESTH
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| 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 |
$1,425.86
|
| 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 |
$448.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$407.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$232.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,330.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.84
|
| 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 |
$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 |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| 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 DRESSING CHANGE UNDER ANESTH
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
361
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$448.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$407.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$378.19
|
| 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
|
|
