|
HC DRSNG WOUND VAC LG
|
Facility
|
OP
|
$343.77
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$292.20 |
| Rate for Payer: Adventist Health Commercial |
$68.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$189.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$257.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.60
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cigna of CA HMO |
$220.01
|
| Rate for Payer: Cigna of CA PPO |
$254.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$292.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$292.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$240.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.51
|
| Rate for Payer: EPIC Health Plan Senior |
$137.51
|
| Rate for Payer: Galaxy Health WC |
$292.20
|
| Rate for Payer: Global Benefits Group Commercial |
$206.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$218.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$240.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$240.64
|
| Rate for Payer: Multiplan Commercial |
$275.02
|
| Rate for Payer: Networks By Design Commercial |
$223.45
|
| Rate for Payer: Prime Health Services Commercial |
$292.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$206.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$206.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.88
|
| Rate for Payer: United Healthcare All Other HMO |
$171.88
|
| Rate for Payer: United Healthcare HMO Rider |
$171.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$292.20
|
| Rate for Payer: Vantage Medical Group Senior |
$292.20
|
|
|
HC DRSNG WOUND VAC MED BLACK
|
Facility
|
OP
|
$279.16
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Adventist Health Commercial |
$55.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$237.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.14
|
| Rate for Payer: Cash Price |
$125.62
|
| Rate for Payer: Cash Price |
$125.62
|
| Rate for Payer: Cigna of CA HMO |
$178.66
|
| Rate for Payer: Cigna of CA PPO |
$206.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$237.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$237.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$237.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$195.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.66
|
| Rate for Payer: EPIC Health Plan Senior |
$111.66
|
| Rate for Payer: Galaxy Health WC |
$237.29
|
| Rate for Payer: Global Benefits Group Commercial |
$167.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$195.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$195.41
|
| Rate for Payer: Multiplan Commercial |
$223.33
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$237.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$167.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$167.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.58
|
| Rate for Payer: United Healthcare All Other HMO |
$139.58
|
| Rate for Payer: United Healthcare HMO Rider |
$139.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$237.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$237.29
|
| Rate for Payer: Vantage Medical Group Senior |
$237.29
|
|
|
HC DRSNG WOUND VAC MED BLACK
|
Facility
|
IP
|
$279.16
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.83 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Adventist Health Commercial |
$55.83
|
| Rate for Payer: Cash Price |
$125.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$195.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.66
|
| Rate for Payer: EPIC Health Plan Senior |
$111.66
|
| Rate for Payer: Galaxy Health WC |
$237.29
|
| Rate for Payer: Global Benefits Group Commercial |
$167.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$223.33
|
| Rate for Payer: Networks By Design Commercial |
$181.45
|
| Rate for Payer: Prime Health Services Commercial |
$237.29
|
|
|
HC DRSNG WOUND VAC MED SLVR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901609001
|
|
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: 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: 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 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
|
|
|
HC DRSNG WOUND VAC MED SLVR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901609001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| 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: 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| 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 DRSNG WOUND VAC THIN
|
Facility
|
OP
|
$364.82
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$310.10 |
| Rate for Payer: Adventist Health Commercial |
$72.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.10
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Cigna of CA HMO |
$233.48
|
| Rate for Payer: Cigna of CA PPO |
$269.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$310.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.93
|
| Rate for Payer: EPIC Health Plan Senior |
$145.93
|
| Rate for Payer: Galaxy Health WC |
$310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$218.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$255.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$255.37
|
| Rate for Payer: Multiplan Commercial |
$291.86
|
| Rate for Payer: Networks By Design Commercial |
$237.13
|
| Rate for Payer: Prime Health Services Commercial |
$310.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.41
|
| Rate for Payer: United Healthcare All Other HMO |
$182.41
|
| Rate for Payer: United Healthcare HMO Rider |
$182.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$182.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.10
|
| Rate for Payer: Vantage Medical Group Senior |
$310.10
|
|
|
HC DRSNG WOUND VAC THIN
|
Facility
|
IP
|
$364.82
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$310.10 |
| Rate for Payer: Adventist Health Commercial |
$72.96
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.93
|
| Rate for Payer: EPIC Health Plan Senior |
$145.93
|
| Rate for Payer: Galaxy Health WC |
$310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$218.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.56
|
| Rate for Payer: Multiplan Commercial |
$291.86
|
| Rate for Payer: Networks By Design Commercial |
$237.13
|
| Rate for Payer: Prime Health Services Commercial |
$310.10
|
|
|
HC DRSNG WOUND VAC THIN FOAM
|
Facility
|
IP
|
$294.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.91 |
| Max. Negotiated Rate |
$250.38 |
| Rate for Payer: Adventist Health Commercial |
$58.91
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.82
|
| Rate for Payer: EPIC Health Plan Senior |
$117.82
|
| Rate for Payer: Galaxy Health WC |
$250.38
|
| Rate for Payer: Global Benefits Group Commercial |
$176.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.69
|
| Rate for Payer: Multiplan Commercial |
$235.65
|
| Rate for Payer: Networks By Design Commercial |
$191.46
|
| Rate for Payer: Prime Health Services Commercial |
$250.38
|
|
|
HC DRSNG WOUND VAC THIN FOAM
|
Facility
|
OP
|
$294.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$250.38 |
| Rate for Payer: Adventist Health Commercial |
$58.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$250.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.02
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Cash Price |
$132.55
|
| Rate for Payer: Cigna of CA HMO |
$188.52
|
| Rate for Payer: Cigna of CA PPO |
$217.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$250.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$250.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.82
|
| Rate for Payer: EPIC Health Plan Senior |
$117.82
|
| Rate for Payer: Galaxy Health WC |
$250.38
|
| Rate for Payer: Global Benefits Group Commercial |
$176.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.19
|
| Rate for Payer: Multiplan Commercial |
$235.65
|
| Rate for Payer: Networks By Design Commercial |
$191.46
|
| Rate for Payer: Prime Health Services Commercial |
$250.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$176.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$147.28
|
| Rate for Payer: United Healthcare All Other HMO |
$147.28
|
| Rate for Payer: United Healthcare HMO Rider |
$147.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$250.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.38
|
| Rate for Payer: Vantage Medical Group Senior |
$250.38
|
|
|
HC DRSNG WOUND VAC VERAFLO LRG
|
Facility
|
OP
|
$983.85
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$836.27 |
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$541.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$631.34
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Cigna of CA HMO |
$629.66
|
| Rate for Payer: Cigna of CA PPO |
$728.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$836.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$836.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$836.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$580.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$688.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.70
|
| Rate for Payer: Multiplan Commercial |
$787.08
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$590.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$590.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.93
|
| Rate for Payer: United Healthcare All Other HMO |
$491.93
|
| Rate for Payer: United Healthcare HMO Rider |
$491.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$491.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$836.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$836.27
|
| Rate for Payer: Vantage Medical Group Senior |
$836.27
|
|
|
HC DRSNG WOUND VAC VERAFLO LRG
|
Facility
|
IP
|
$983.85
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.77 |
| Max. Negotiated Rate |
$836.27 |
| Rate for Payer: Cash Price |
$442.73
|
| Rate for Payer: Adventist Health Commercial |
$196.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$688.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$393.54
|
| Rate for Payer: EPIC Health Plan Senior |
$393.54
|
| Rate for Payer: Galaxy Health WC |
$836.27
|
| Rate for Payer: Global Benefits Group Commercial |
$590.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$624.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$580.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.12
|
| Rate for Payer: Multiplan Commercial |
$787.08
|
| Rate for Payer: Networks By Design Commercial |
$639.50
|
| Rate for Payer: Prime Health Services Commercial |
$836.27
|
|
|
HC DRSNG WOUND VAC VERAFLO MED
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.19
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC DRSNG WOUND VAC VERAFLO MED
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC DRSNG WOUND VAC WHITE LG
|
Facility
|
IP
|
$91.28
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$77.59 |
| Rate for Payer: Adventist Health Commercial |
$18.26
|
| Rate for Payer: Cash Price |
$41.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.51
|
| Rate for Payer: EPIC Health Plan Senior |
$36.51
|
| Rate for Payer: Galaxy Health WC |
$77.59
|
| Rate for Payer: Global Benefits Group Commercial |
$54.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.91
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$59.33
|
| Rate for Payer: Prime Health Services Commercial |
$77.59
|
|
|
HC DRSNG WOUND VAC WHITE LG
|
Facility
|
OP
|
$91.28
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$77.59 |
| Rate for Payer: United Healthcare HMO Rider |
$45.64
|
| Rate for Payer: Adventist Health Commercial |
$18.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.57
|
| Rate for Payer: Cash Price |
$41.08
|
| Rate for Payer: Cash Price |
$41.08
|
| Rate for Payer: Cigna of CA HMO |
$58.42
|
| Rate for Payer: Cigna of CA PPO |
$67.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.51
|
| Rate for Payer: EPIC Health Plan Senior |
$36.51
|
| Rate for Payer: Galaxy Health WC |
$77.59
|
| Rate for Payer: Global Benefits Group Commercial |
$54.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.90
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$59.33
|
| Rate for Payer: Prime Health Services Commercial |
$77.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.64
|
| Rate for Payer: United Healthcare All Other HMO |
$45.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.59
|
| Rate for Payer: Vantage Medical Group Senior |
$77.59
|
|
|
HC DRSNG WOUND VAC WHITE SM
|
Facility
|
IP
|
$79.29
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$67.40 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.72
|
| Rate for Payer: EPIC Health Plan Senior |
$31.72
|
| Rate for Payer: Galaxy Health WC |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.03
|
| Rate for Payer: Multiplan Commercial |
$63.43
|
| Rate for Payer: Networks By Design Commercial |
$51.54
|
| Rate for Payer: Prime Health Services Commercial |
$67.40
|
|
|
HC DRSNG WOUND VAC WHITE SM
|
Facility
|
OP
|
$79.29
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.88
|
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Cigna of CA HMO |
$50.75
|
| Rate for Payer: Cigna of CA PPO |
$58.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.72
|
| Rate for Payer: EPIC Health Plan Senior |
$31.72
|
| Rate for Payer: Galaxy Health WC |
$67.40
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.50
|
| Rate for Payer: Multiplan Commercial |
$63.43
|
| Rate for Payer: Networks By Design Commercial |
$51.54
|
| Rate for Payer: Prime Health Services Commercial |
$67.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.65
|
| Rate for Payer: United Healthcare All Other HMO |
$39.65
|
| Rate for Payer: United Healthcare HMO Rider |
$39.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.40
|
| Rate for Payer: Vantage Medical Group Senior |
$67.40
|
|
|
HC DRSNG XERFORM ROLL 4"X3YD
|
Facility
|
OP
|
$29.27
|
|
|
Service Code
|
CPT A6224
|
| Hospital Charge Code |
901695706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.78
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Cigna of CA HMO |
$18.73
|
| Rate for Payer: Cigna of CA PPO |
$21.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.71
|
| Rate for Payer: EPIC Health Plan Senior |
$11.71
|
| Rate for Payer: Galaxy Health WC |
$24.88
|
| Rate for Payer: Global Benefits Group Commercial |
$17.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$23.42
|
| Rate for Payer: Networks By Design Commercial |
$19.03
|
| Rate for Payer: Prime Health Services Commercial |
$24.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.63
|
| Rate for Payer: United Healthcare All Other HMO |
$14.63
|
| Rate for Payer: United Healthcare HMO Rider |
$14.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.88
|
| Rate for Payer: Vantage Medical Group Senior |
$24.88
|
|
|
HC DRSNG XERFORM ROLL 4"X3YD
|
Facility
|
IP
|
$29.27
|
|
|
Service Code
|
CPT A6224
|
| Hospital Charge Code |
901695706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Adventist Health Commercial |
$5.85
|
| Rate for Payer: Cash Price |
$13.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.71
|
| Rate for Payer: EPIC Health Plan Senior |
$11.71
|
| Rate for Payer: Galaxy Health WC |
$24.88
|
| Rate for Payer: Global Benefits Group Commercial |
$17.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$23.42
|
| Rate for Payer: Networks By Design Commercial |
$19.03
|
| Rate for Payer: Prime Health Services Commercial |
$24.88
|
|
|
HC DRUGS ABUSE SCREEN,URINE(7)COC
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$957.10 |
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.03
|
| Rate for Payer: Blue Shield of California Commercial |
$111.56
|
| Rate for Payer: Blue Shield of California Commercial |
$519.09
|
| Rate for Payer: Blue Shield of California Commercial |
$168.67
|
| Rate for Payer: Blue Shield of California Commercial |
$784.82
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA HMO |
$720.64
|
| Rate for Payer: Cigna of CA PPO |
$833.24
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$788.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: Galaxy Health WC |
$957.10
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$675.60
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$715.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Multiplan Commercial |
$900.80
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Networks By Design Commercial |
$731.90
|
| Rate for Payer: Prime Health Services Commercial |
$957.10
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$675.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$675.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUGS ABUSE SCREEN,URINE(7)COC
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$225.20 |
| Max. Negotiated Rate |
$957.10 |
| Rate for Payer: Adventist Health Commercial |
$225.20
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$788.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.40
|
| Rate for Payer: EPIC Health Plan Senior |
$450.40
|
| Rate for Payer: Galaxy Health WC |
$957.10
|
| Rate for Payer: Global Benefits Group Commercial |
$675.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$715.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$664.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.24
|
| Rate for Payer: Multiplan Commercial |
$900.80
|
| Rate for Payer: Networks By Design Commercial |
$731.90
|
| Rate for Payer: Prime Health Services Commercial |
$957.10
|
|
|
HC DRUG SCREEN AMPHETAMINES
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$636.03 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.03
|
| Rate for Payer: Blue Shield of California Commercial |
$128.16
|
| Rate for Payer: Blue Shield of California Commercial |
$111.56
|
| Rate for Payer: Blue Shield of California Commercial |
$193.77
|
| Rate for Payer: Blue Shield of California Commercial |
$168.67
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO |
$177.92
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Cigna of CA PPO |
$205.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$194.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN AMPHETAMINES
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$194.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
|
|
HC DRUG SCREEN BARBITUATES
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910325
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$636.03 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.03
|
| Rate for Payer: Blue Shield of California Commercial |
$128.16
|
| Rate for Payer: Blue Shield of California Commercial |
$111.56
|
| Rate for Payer: Blue Shield of California Commercial |
$193.77
|
| Rate for Payer: Blue Shield of California Commercial |
$168.67
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO |
$177.92
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Cigna of CA PPO |
$205.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$194.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN BARBITUATES
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910325
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Galaxy Health WC |
$236.30
|
| Rate for Payer: Adventist Health Commercial |
$55.60
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$194.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Senior |
$111.20
|
| Rate for Payer: Global Benefits Group Commercial |
$166.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$176.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$222.40
|
| Rate for Payer: Networks By Design Commercial |
$180.70
|
| Rate for Payer: Prime Health Services Commercial |
$236.30
|
|
