|
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: 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
|
|
|
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 |
$46.86 |
| Rate for Payer: Adventist Health Commercial |
$9.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.86
|
| 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 |
$30.83
|
| Rate for Payer: Cash Price |
$21.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.63
|
| 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 Foundation Hospitals Commercial/Self Funded |
$30.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.35
|
| 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 |
$21.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.63
|
| 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 Foundation Hospitals Commercial/Self Funded |
$30.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.35
|
| 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 |
$46.86
|
| 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 |
$70.23
|
| Rate for Payer: Cash Price |
$49.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.61
|
| 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 Foundation Hospitals Commercial/Self Funded |
$69.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.57
|
| 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 |
$49.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.61
|
| 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 Foundation Hospitals Commercial/Self Funded |
$69.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.57
|
| 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
|
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 |
$73.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.83
|
| 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 Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| 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 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 |
$139.04 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.04
|
| 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 |
$104.35
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.83
|
| 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 Foundation Hospitals Commercial/Self Funded |
$103.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.94
|
| 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 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: Cigna of CA PPO |
$86.39
|
| Rate for Payer: Adventist Health Commercial |
$23.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.77
|
| 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 |
$74.91
|
| Rate for Payer: Cash Price |
$52.53
|
| Rate for Payer: Cash Price |
$52.53
|
| Rate for Payer: Cigna of CA HMO |
$74.71
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.72
|
| 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 Foundation Hospitals Commercial/Self Funded |
$74.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.88
|
| 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 |
$52.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.72
|
| 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 Foundation Hospitals Commercial/Self Funded |
$74.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.88
|
| 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
|
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 |
$9.59
|
| 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 |
$15.42
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: Cash Price |
$10.81
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.82
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.18
|
| 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 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 |
$10.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.82
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.18
|
| 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 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 |
$12.31 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.31
|
| 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 |
$6.37
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cash Price |
$4.46
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.94
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.85
|
| 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 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 |
$4.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.94
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.85
|
| 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 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 |
$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 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 |
$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 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 |
$65.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$101.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$92.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85.55
|
| 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 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: Cigna of CA PPO |
$107.30
|
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.12
|
| 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 |
$72.20
|
| Rate for Payer: Blue Shield of California Commercial |
$101.06
|
| Rate for Payer: Blue Shield of California Commercial |
$66.84
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cigna of CA HMO |
$92.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$101.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.37
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$92.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.34
|
| 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 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 |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$2,612.70
|
| Rate for Payer: Cash Price |
$2,612.70
|
| Rate for Payer: Cash Price |
$2,612.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,064.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,686.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$594.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,425.54
|
| 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 |
$2,903.00
|
| 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 |
$2,612.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,064.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,686.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,425.54
|
| 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
|
OP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
915352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Adventist Health Commercial |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.45
|
| Rate for Payer: Blue Shield of California Commercial |
$36.14
|
| Rate for Payer: Blue Shield of California Commercial |
$23.83
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.90
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC DROP LOCK RETAINER PER BAR
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
905352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Adventist Health Commercial |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.45
|
| Rate for Payer: Blue Shield of California Commercial |
$36.14
|
| Rate for Payer: Blue Shield of California Commercial |
$23.83
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.90
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC DROP LOCK RETAINER PER BAR
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
905352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.73
|
| 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 |
$30.55
|
| 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
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$29.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.73
|
| 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 |
$30.55
|
| 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
|
|
|
HC DRSG AQUACEL HYDROFIBER 23CMX30CM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC DRSG AQUACEL HYDROFIBER 23CMX30CM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
