|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
IP
|
$2,564.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$512.80 |
| Max. Negotiated Rate |
$2,307.60 |
| Rate for Payer: Adventist Health Commercial |
$512.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,051.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,794.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,025.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,025.60
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,307.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,628.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,512.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.80
|
| Rate for Payer: Multiplan Commercial |
$1,923.00
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
|
|
HC DRES & OR DEB OF BURN INT/SUB MED
|
Facility
|
IP
|
$2,157.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$431.40 |
| Max. Negotiated Rate |
$1,941.30 |
| Rate for Payer: Adventist Health Commercial |
$431.40
|
| Rate for Payer: Cash Price |
$970.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,725.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,509.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$862.80
|
| Rate for Payer: Galaxy Health WC |
$1,833.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,294.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,941.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,369.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,272.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.40
|
| Rate for Payer: Multiplan Commercial |
$1,617.75
|
| Rate for Payer: Networks By Design Commercial |
$1,402.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,833.45
|
|
|
HC DRES & OR DEB OF BURN INT/SUB MED
|
Facility
|
OP
|
$2,157.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$431.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$970.65
|
| Rate for Payer: Cash Price |
$970.65
|
| Rate for Payer: Cash Price |
$970.65
|
| Rate for Payer: Cash Price |
$970.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,725.60
|
| Rate for Payer: Cigna of CA HMO |
$1,380.48
|
| Rate for Payer: Cigna of CA PPO |
$1,596.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,509.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,833.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,294.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,941.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,369.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,617.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,402.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,833.45
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,294.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,078.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,078.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,078.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DRES & OR DEB OF BURN INT/SUB MED
|
Facility
|
OP
|
$2,157.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$884.37
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$628.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$970.65
|
| Rate for Payer: Cash Price |
$970.65
|
| Rate for Payer: Cash Price |
$970.65
|
| Rate for Payer: Cash Price |
$970.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,725.60
|
| Rate for Payer: Cigna of CA HMO |
$1,380.48
|
| Rate for Payer: Cigna of CA PPO |
$1,596.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,509.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,833.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,294.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,941.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,369.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,617.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$1,402.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,833.45
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,294.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,294.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DRES & OR DEB OF BURN INT/SUB MED
|
Facility
|
IP
|
$2,157.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$431.40 |
| Max. Negotiated Rate |
$1,941.30 |
| Rate for Payer: Adventist Health Commercial |
$431.40
|
| Rate for Payer: Cash Price |
$970.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,725.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,509.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$862.80
|
| Rate for Payer: Galaxy Health WC |
$1,833.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,294.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,941.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,369.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,272.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.40
|
| Rate for Payer: Multiplan Commercial |
$1,617.75
|
| Rate for Payer: Networks By Design Commercial |
$1,402.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,833.45
|
|
|
HC DRES & OR DEB OF BURN INT/SUB SMALL
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
900501046
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$623.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$315.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,216.00
|
| Rate for Payer: Cigna of CA HMO |
$972.80
|
| Rate for Payer: Cigna of CA PPO |
$1,124.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,292.00
|
| Rate for Payer: Global Benefits Group Commercial |
$912.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,368.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$965.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$988.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,292.00
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$912.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$912.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DRES & OR DEB OF BURN INT/SUB SMALL
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
900501046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Adventist Health Commercial |
$304.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,216.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$608.00
|
| Rate for Payer: EPIC Health Plan Senior |
$608.00
|
| Rate for Payer: Galaxy Health WC |
$1,292.00
|
| Rate for Payer: Global Benefits Group Commercial |
$912.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,368.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$965.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$896.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.00
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: Networks By Design Commercial |
$988.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,292.00
|
|
|
HC DRES & OR DEB OF BURN INT/SUB SMALL
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
900501046
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Adventist Health Commercial |
$304.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,216.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$608.00
|
| Rate for Payer: EPIC Health Plan Senior |
$608.00
|
| Rate for Payer: Galaxy Health WC |
$1,292.00
|
| Rate for Payer: Global Benefits Group Commercial |
$912.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,368.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$965.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$896.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.00
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: Networks By Design Commercial |
$988.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,292.00
|
|
|
HC DRES & OR DEB OF BURN INT/SUB SMALL
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
900501046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$304.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,216.00
|
| Rate for Payer: Cigna of CA HMO |
$972.80
|
| Rate for Payer: Cigna of CA PPO |
$1,124.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,292.00
|
| Rate for Payer: Global Benefits Group Commercial |
$912.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,368.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$965.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$988.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,292.00
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$760.00
|
| Rate for Payer: United Healthcare All Other HMO |
$760.00
|
| Rate for Payer: United Healthcare HMO Rider |
$760.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$760.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC DRESSING CHANGE UNDER ANESTH
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$950.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Central Health Plan Commercial |
$693.60
|
| Rate for Payer: Cigna of CA HMO |
$554.88
|
| Rate for Payer: Cigna of CA PPO |
$641.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$606.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$736.95
|
| Rate for Payer: Global Benefits Group Commercial |
$520.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$780.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$550.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$314.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,330.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$650.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$563.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$736.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$433.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC DRESSING CHANGE UNDER ANESTH
|
Facility
|
OP
|
$867.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Central Health Plan Commercial |
$693.60
|
| Rate for Payer: Cigna of CA HMO |
$554.88
|
| Rate for Payer: Cigna of CA PPO |
$641.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$606.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$736.95
|
| Rate for Payer: Global Benefits Group Commercial |
$520.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$780.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$550.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$314.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$650.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$563.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$736.95
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$433.50
|
| Rate for Payer: United Healthcare All Other HMO |
$433.50
|
| Rate for Payer: United Healthcare HMO Rider |
$433.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$433.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC DRESSING CHANGE UNDER ANESTH
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$780.30 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Central Health Plan Commercial |
$693.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$606.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.80
|
| Rate for Payer: EPIC Health Plan Senior |
$346.80
|
| Rate for Payer: Galaxy Health WC |
$736.95
|
| Rate for Payer: Global Benefits Group Commercial |
$520.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$780.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$550.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$511.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.40
|
| Rate for Payer: Multiplan Commercial |
$650.25
|
| Rate for Payer: Networks By Design Commercial |
$563.55
|
| Rate for Payer: Prime Health Services Commercial |
$736.95
|
|
|
HC DRESSING CHANGE UNDER ANESTH
|
Facility
|
IP
|
$867.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$780.30 |
| Rate for Payer: Adventist Health Commercial |
$173.40
|
| Rate for Payer: Cash Price |
$390.15
|
| Rate for Payer: Central Health Plan Commercial |
$693.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$606.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$346.80
|
| Rate for Payer: EPIC Health Plan Senior |
$346.80
|
| Rate for Payer: Galaxy Health WC |
$736.95
|
| Rate for Payer: Global Benefits Group Commercial |
$520.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$780.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$550.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$511.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.40
|
| Rate for Payer: Multiplan Commercial |
$650.25
|
| Rate for Payer: Networks By Design Commercial |
$563.55
|
| Rate for Payer: Prime Health Services Commercial |
$736.95
|
|
|
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 |
$43.24 |
| Rate for Payer: Adventist Health Commercial |
$9.61
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Central Health Plan Commercial |
$38.44
|
| 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: Health Management Network EPO/PPO |
$43.24
|
| 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 |
$9.61
|
| Rate for Payer: Multiplan Commercial |
$36.04
|
| Rate for Payer: Networks By Design Commercial |
$31.23
|
| Rate for Payer: Prime Health Services Commercial |
$40.84
|
|
|
HC DRESSING EXUFIBER 6X6"
|
Facility
|
OP
|
$48.05
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$43.24 |
| Rate for Payer: Adventist Health Commercial |
$9.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.35
|
| 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 Exchange |
$23.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.95
|
| Rate for Payer: Blue Shield of California Commercial |
$30.46
|
| Rate for Payer: Blue Shield of California EPN |
$19.17
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Central Health Plan Commercial |
$38.44
|
| 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: Health Management Network EPO/PPO |
$43.24
|
| 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 |
$9.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.63
|
| Rate for Payer: Multiplan Commercial |
$36.04
|
| Rate for Payer: Networks By Design Commercial |
$31.23
|
| Rate for Payer: Prime Health Services Commercial |
$40.84
|
| Rate for Payer: Riverside University Health System MISP |
$19.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.02
|
| Rate for Payer: United Healthcare All Other HMO |
$24.02
|
| Rate for Payer: United Healthcare HMO Rider |
$24.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.84
|
| Rate for Payer: Vantage Medical Group Senior |
$40.84
|
|
|
HC DRESSING EXUFIBER AG 6X6"
|
Facility
|
IP
|
$109.21
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$98.29 |
| Rate for Payer: Adventist Health Commercial |
$21.84
|
| Rate for Payer: Cash Price |
$49.14
|
| Rate for Payer: Central Health Plan Commercial |
$87.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.68
|
| Rate for Payer: EPIC Health Plan Senior |
$43.68
|
| Rate for Payer: Galaxy Health WC |
$92.83
|
| Rate for Payer: Global Benefits Group Commercial |
$65.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$81.91
|
| Rate for Payer: Networks By Design Commercial |
$70.99
|
| Rate for Payer: Prime Health Services Commercial |
$92.83
|
|
|
HC DRESSING EXUFIBER AG 6X6"
|
Facility
|
OP
|
$109.21
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$98.29 |
| Rate for Payer: Adventist Health Commercial |
$21.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.53
|
| Rate for Payer: Blue Shield of California Commercial |
$69.24
|
| Rate for Payer: Blue Shield of California EPN |
$43.57
|
| Rate for Payer: Cash Price |
$49.14
|
| Rate for Payer: Cash Price |
$49.14
|
| Rate for Payer: Central Health Plan Commercial |
$87.37
|
| Rate for Payer: Cigna of CA HMO |
$69.89
|
| Rate for Payer: Cigna of CA PPO |
$80.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.68
|
| Rate for Payer: EPIC Health Plan Senior |
$43.68
|
| Rate for Payer: Galaxy Health WC |
$92.83
|
| Rate for Payer: Global Benefits Group Commercial |
$65.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76.45
|
| Rate for Payer: Multiplan Commercial |
$81.91
|
| Rate for Payer: Networks By Design Commercial |
$70.99
|
| Rate for Payer: Prime Health Services Commercial |
$92.83
|
| Rate for Payer: Riverside University Health System MISP |
$43.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.60
|
| Rate for Payer: United Healthcare All Other HMO |
$54.60
|
| Rate for Payer: United Healthcare HMO Rider |
$54.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.83
|
| Rate for Payer: Vantage Medical Group Senior |
$92.83
|
|
|
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 |
$146.35 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.71
|
| 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 Exchange |
$78.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.59
|
| Rate for Payer: Blue Shield of California Commercial |
$103.09
|
| Rate for Payer: Blue Shield of California EPN |
$64.88
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Central Health Plan Commercial |
$130.09
|
| 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: Health Management Network EPO/PPO |
$146.35
|
| 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 |
$32.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.83
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$105.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
| Rate for Payer: Riverside University Health System MISP |
$65.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.31
|
| Rate for Payer: United Healthcare All Other HMO |
$81.31
|
| Rate for Payer: United Healthcare HMO Rider |
$81.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.22
|
| Rate for Payer: Vantage Medical Group Senior |
$138.22
|
|
|
HC DRESSING EXUFIBER AG 8X12"
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901698257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$146.35 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Central Health Plan Commercial |
$130.09
|
| 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: Health Management Network EPO/PPO |
$146.35
|
| 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 |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$105.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
|
|
HC DRESSING HYDROFERA FOAM 8X8"
|
Facility
|
OP
|
$116.43
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$104.79 |
| Rate for Payer: Adventist Health Commercial |
$23.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.73
|
| Rate for Payer: Blue Shield of California Commercial |
$73.82
|
| Rate for Payer: Blue Shield of California EPN |
$46.46
|
| Rate for Payer: Cash Price |
$52.39
|
| Rate for Payer: Cash Price |
$52.39
|
| Rate for Payer: Central Health Plan Commercial |
$93.14
|
| Rate for Payer: Cigna of CA HMO |
$74.52
|
| Rate for Payer: Cigna of CA PPO |
$86.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$98.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$98.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.57
|
| Rate for Payer: EPIC Health Plan Senior |
$46.57
|
| Rate for Payer: Galaxy Health WC |
$98.97
|
| Rate for Payer: Global Benefits Group Commercial |
$69.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$81.50
|
| Rate for Payer: Multiplan Commercial |
$87.32
|
| Rate for Payer: Networks By Design Commercial |
$75.68
|
| Rate for Payer: Prime Health Services Commercial |
$98.97
|
| Rate for Payer: Riverside University Health System MISP |
$46.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.22
|
| Rate for Payer: United Healthcare All Other HMO |
$58.22
|
| Rate for Payer: United Healthcare HMO Rider |
$58.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$98.97
|
| Rate for Payer: Vantage Medical Group Senior |
$98.97
|
|
|
HC DRESSING HYDROFERA FOAM 8X8"
|
Facility
|
IP
|
$116.43
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$104.79 |
| Rate for Payer: Adventist Health Commercial |
$23.29
|
| Rate for Payer: Cash Price |
$52.39
|
| Rate for Payer: Central Health Plan Commercial |
$93.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.57
|
| Rate for Payer: EPIC Health Plan Senior |
$46.57
|
| Rate for Payer: Galaxy Health WC |
$98.97
|
| Rate for Payer: Global Benefits Group Commercial |
$69.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.29
|
| Rate for Payer: Multiplan Commercial |
$87.32
|
| Rate for Payer: Networks By Design Commercial |
$75.68
|
| Rate for Payer: Prime Health Services Commercial |
$98.97
|
|
|
HC DRESSING MEPITEL ONE 2X3"
|
Facility
|
IP
|
$23.94
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901607884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Central Health Plan Commercial |
$19.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$17.95
|
| Rate for Payer: Networks By Design Commercial |
$15.56
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
|
|
HC DRESSING MEPITEL ONE 2X3"
|
Facility
|
OP
|
$23.94
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901607884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.93
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.55
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Central Health Plan Commercial |
$19.15
|
| Rate for Payer: Cigna of CA HMO |
$15.32
|
| Rate for Payer: Cigna of CA PPO |
$17.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.76
|
| Rate for Payer: Multiplan Commercial |
$17.95
|
| Rate for Payer: Networks By Design Commercial |
$15.56
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
| Rate for Payer: Riverside University Health System MISP |
$9.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.97
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$11.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.35
|
|
|
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 |
$8.93 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.94
|
| 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: Health Management Network EPO/PPO |
$8.93
|
| 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 |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$7.44
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$8.43
|
|
|
HC DRES TEGADERM 8X6" TRANSPARENT FRAME STYLE
|
Facility
|
OP
|
$9.92
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901605554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$10.86 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.86
|
| 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 Exchange |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.77
|
| Rate for Payer: Blue Shield of California Commercial |
$6.29
|
| Rate for Payer: Blue Shield of California EPN |
$3.96
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.94
|
| 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: Health Management Network EPO/PPO |
$8.93
|
| 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 |
$1.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$7.44
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$8.43
|
| Rate for Payer: Riverside University Health System MISP |
$3.97
|
| 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
|
|
