|
HC DRAIN ROUND 15FR W/TROCAR
|
Facility
|
IP
|
$184.73
|
|
| Hospital Charge Code |
901698884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$166.26 |
| Rate for Payer: Adventist Health Commercial |
$36.95
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Central Health Plan Commercial |
$147.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.89
|
| Rate for Payer: EPIC Health Plan Senior |
$73.89
|
| Rate for Payer: Galaxy Health WC |
$157.02
|
| Rate for Payer: Global Benefits Group Commercial |
$110.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.95
|
| Rate for Payer: Multiplan Commercial |
$138.55
|
| Rate for Payer: Networks By Design Commercial |
$120.07
|
| Rate for Payer: Prime Health Services Commercial |
$157.02
|
|
|
HC DRAIN ROUND 15FR W/TROCAR
|
Facility
|
OP
|
$184.73
|
|
| Hospital Charge Code |
901698884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$166.26 |
| Rate for Payer: Adventist Health Commercial |
$36.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.49
|
| Rate for Payer: Blue Shield of California Commercial |
$112.87
|
| Rate for Payer: Blue Shield of California EPN |
$73.71
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Central Health Plan Commercial |
$147.78
|
| Rate for Payer: Cigna of CA HMO |
$118.23
|
| Rate for Payer: Cigna of CA PPO |
$136.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.89
|
| Rate for Payer: EPIC Health Plan Senior |
$73.89
|
| Rate for Payer: Galaxy Health WC |
$157.02
|
| Rate for Payer: Global Benefits Group Commercial |
$110.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.26
|
| Rate for Payer: InnovAge PACE Commercial |
$92.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$129.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$129.31
|
| Rate for Payer: Multiplan Commercial |
$138.55
|
| Rate for Payer: Networks By Design Commercial |
$120.07
|
| Rate for Payer: Prime Health Services Commercial |
$157.02
|
| Rate for Payer: Riverside University Health System MISP |
$73.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.36
|
| Rate for Payer: United Healthcare All Other HMO |
$92.36
|
| Rate for Payer: United Healthcare HMO Rider |
$92.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.02
|
| Rate for Payer: Vantage Medical Group Senior |
$157.02
|
|
|
HC DRAIN ROUND 19FR W/TROCAR
|
Facility
|
IP
|
$191.87
|
|
| Hospital Charge Code |
901603855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC DRAIN ROUND 19FR W/TROCAR
|
Facility
|
OP
|
$191.87
|
|
| Hospital Charge Code |
901603855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.69
|
| Rate for Payer: Blue Shield of California Commercial |
$117.23
|
| Rate for Payer: Blue Shield of California EPN |
$76.56
|
| Rate for Payer: Cash Price |
$105.53
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: InnovAge PACE Commercial |
$95.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Riverside University Health System MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC DRAIN SPONGE EXCILON 4X4" STE
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
CPT A6402
|
| Hospital Charge Code |
901698578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
HC DRAIN SPONGE EXCILON 4X4" STE
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
CPT A6402
|
| Hospital Charge Code |
901698578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.51
|
| Rate for Payer: InnovAge PACE Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
HC DRAIN WOUND 1/8"
|
Facility
|
OP
|
$74.78
|
|
| Hospital Charge Code |
901692010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$67.30 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.92
|
| Rate for Payer: Blue Shield of California Commercial |
$45.69
|
| Rate for Payer: Blue Shield of California EPN |
$29.84
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Central Health Plan Commercial |
$59.82
|
| Rate for Payer: Cigna of CA HMO |
$47.86
|
| Rate for Payer: Cigna of CA PPO |
$55.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.30
|
| Rate for Payer: InnovAge PACE Commercial |
$37.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.35
|
| Rate for Payer: Multiplan Commercial |
$56.09
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
| Rate for Payer: Riverside University Health System MISP |
$29.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.39
|
| Rate for Payer: United Healthcare All Other HMO |
$37.39
|
| Rate for Payer: United Healthcare HMO Rider |
$37.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.56
|
| Rate for Payer: Vantage Medical Group Senior |
$63.56
|
|
|
HC DRAIN WOUND 1/8"
|
Facility
|
IP
|
$74.78
|
|
| Hospital Charge Code |
901692010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$67.30 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Central Health Plan Commercial |
$59.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Multiplan Commercial |
$56.09
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
|
|
HC DRAIN WOUND 1/8"
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901605791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRAIN WOUND 1/8"
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901605791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC DRES AQUACEL AG 4IN X 5IN
|
Facility
|
IP
|
$71.91
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Adventist Health Commercial |
$14.38
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Central Health Plan Commercial |
$57.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.76
|
| Rate for Payer: EPIC Health Plan Senior |
$28.76
|
| Rate for Payer: Galaxy Health WC |
$61.12
|
| Rate for Payer: Global Benefits Group Commercial |
$43.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.38
|
| Rate for Payer: Multiplan Commercial |
$53.93
|
| Rate for Payer: Networks By Design Commercial |
$46.74
|
| Rate for Payer: Prime Health Services Commercial |
$61.12
|
|
|
HC DRES AQUACEL AG 4IN X 5IN
|
Facility
|
OP
|
$71.91
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Adventist Health Commercial |
$14.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.23
|
| Rate for Payer: Blue Shield of California Commercial |
$43.94
|
| Rate for Payer: Blue Shield of California EPN |
$28.69
|
| Rate for Payer: Cash Price |
$39.55
|
| Rate for Payer: Central Health Plan Commercial |
$57.53
|
| Rate for Payer: Cigna of CA HMO |
$46.02
|
| Rate for Payer: Cigna of CA PPO |
$53.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.76
|
| Rate for Payer: EPIC Health Plan Senior |
$28.76
|
| Rate for Payer: Galaxy Health WC |
$61.12
|
| Rate for Payer: Global Benefits Group Commercial |
$43.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.72
|
| Rate for Payer: InnovAge PACE Commercial |
$35.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.34
|
| Rate for Payer: Multiplan Commercial |
$53.93
|
| Rate for Payer: Networks By Design Commercial |
$46.74
|
| Rate for Payer: Prime Health Services Commercial |
$61.12
|
| Rate for Payer: Riverside University Health System MISP |
$28.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.95
|
| Rate for Payer: United Healthcare All Other HMO |
$35.95
|
| Rate for Payer: United Healthcare HMO Rider |
$35.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.12
|
| Rate for Payer: Vantage Medical Group Senior |
$61.12
|
|
|
HC DRES HYDROGEL 4X4 CLEAR CARRADRES
|
Facility
|
OP
|
$24.76
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$22.28 |
| Rate for Payer: Adventist Health Commercial |
$4.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.54
|
| Rate for Payer: Blue Shield of California Commercial |
$15.13
|
| Rate for Payer: Blue Shield of California EPN |
$9.88
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Central Health Plan Commercial |
$19.81
|
| Rate for Payer: Cigna of CA HMO |
$15.85
|
| Rate for Payer: Cigna of CA PPO |
$18.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.90
|
| Rate for Payer: EPIC Health Plan Senior |
$9.90
|
| Rate for Payer: Galaxy Health WC |
$21.05
|
| Rate for Payer: Global Benefits Group Commercial |
$14.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.28
|
| Rate for Payer: InnovAge PACE Commercial |
$12.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.33
|
| Rate for Payer: Multiplan Commercial |
$18.57
|
| Rate for Payer: Networks By Design Commercial |
$16.09
|
| Rate for Payer: Prime Health Services Commercial |
$21.05
|
| Rate for Payer: Riverside University Health System MISP |
$9.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.38
|
| Rate for Payer: United Healthcare HMO Rider |
$12.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.05
|
| Rate for Payer: Vantage Medical Group Senior |
$21.05
|
|
|
HC DRES HYDROGEL 4X4 CLEAR CARRADRES
|
Facility
|
IP
|
$24.76
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$22.28 |
| Rate for Payer: Adventist Health Commercial |
$4.95
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Central Health Plan Commercial |
$19.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.90
|
| Rate for Payer: EPIC Health Plan Senior |
$9.90
|
| Rate for Payer: Galaxy Health WC |
$21.05
|
| Rate for Payer: Global Benefits Group Commercial |
$14.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$18.57
|
| Rate for Payer: Networks By Design Commercial |
$16.09
|
| Rate for Payer: Prime Health Services Commercial |
$21.05
|
|
|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
OP
|
$2,564.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,051.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,410.20
|
| Rate for Payer: Cash Price |
$1,410.20
|
| Rate for Payer: Cash Price |
$1,410.20
|
| Rate for Payer: Cash Price |
$1,410.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,051.20
|
| Rate for Payer: Cigna of CA HMO |
$1,640.96
|
| Rate for Payer: Cigna of CA PPO |
$1,897.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| 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: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,923.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,538.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,538.40
|
| 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 |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
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
|
450
|
| Min. Negotiated Rate |
$512.80 |
| Max. Negotiated Rate |
$2,307.60 |
| Rate for Payer: Adventist Health Commercial |
$512.80
|
| Rate for Payer: Cash Price |
$1,410.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,051.20
|
| 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 Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,587.12
|
| 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 LG
|
Facility
|
OP
|
$2,564.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$512.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,410.20
|
| Rate for Payer: Cash Price |
$1,410.20
|
| Rate for Payer: Cash Price |
$1,410.20
|
| Rate for Payer: Cash Price |
$1,410.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,051.20
|
| Rate for Payer: Cigna of CA HMO |
$1,640.96
|
| Rate for Payer: Cigna of CA PPO |
$1,897.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| 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: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,923.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,538.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,282.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,282.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,282.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
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 |
$1,410.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,051.20
|
| 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 Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,587.12
|
| 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
|
OP
|
$2,157.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$6,333.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,186.35
|
| Rate for Payer: Cash Price |
$1,186.35
|
| Rate for Payer: Cash Price |
$1,186.35
|
| Rate for Payer: Cash Price |
$1,186.35
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,438.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC DRES & OR DEB OF BURN INT/SUB 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 |
$6,333.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$1,186.35
|
| Rate for Payer: Cash Price |
$1,186.35
|
| Rate for Payer: Cash Price |
$1,186.35
|
| Rate for Payer: Cash Price |
$1,186.35
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,438.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC DRES & OR DEB OF BURN INT/SUB 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 |
$1,186.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,725.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,438.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$821.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,335.18
|
| 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
|
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 |
$1,186.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,725.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,438.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$821.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,335.18
|
| 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
|
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 |
$836.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,216.00
|
| 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 Permanente of CA Commercial/Self Funded |
$1,013.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$940.88
|
| 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
|
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 |
$836.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,216.00
|
| 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 Permanente of CA Commercial/Self Funded |
$1,013.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$940.88
|
| 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 |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cash Price |
$836.00
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,013.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
