|
HC DRAIN PVC 1/8" CONSTAVAC
|
Facility
|
IP
|
$63.96
|
|
| Hospital Charge Code |
901602283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$57.56 |
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Central Health Plan Commercial |
$51.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.58
|
| Rate for Payer: Galaxy Health WC |
$54.37
|
| Rate for Payer: Global Benefits Group Commercial |
$38.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.79
|
| Rate for Payer: Multiplan Commercial |
$47.97
|
| Rate for Payer: Networks By Design Commercial |
$41.57
|
| Rate for Payer: Prime Health Services Commercial |
$54.37
|
|
|
HC DRAIN PVC 3/32X5IN CONSTAVAC
|
Facility
|
OP
|
$125.40
|
|
| Hospital Charge Code |
901602282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$112.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.09
|
| Rate for Payer: Blue Distinction Transplant |
$75.24
|
| Rate for Payer: Blue Shield of California Commercial |
$78.88
|
| Rate for Payer: Blue Shield of California EPN |
$61.32
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Central Health Plan Commercial |
$100.32
|
| Rate for Payer: Cigna of CA HMO |
$80.26
|
| Rate for Payer: Cigna of CA PPO |
$92.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.59
|
| Rate for Payer: Dignity Health Media |
$106.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.16
|
| Rate for Payer: Galaxy Health WC |
$106.59
|
| Rate for Payer: Global Benefits Group Commercial |
$75.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$94.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.08
|
| Rate for Payer: Multiplan Commercial |
$94.05
|
| Rate for Payer: Networks By Design Commercial |
$81.51
|
| Rate for Payer: Prime Health Services Commercial |
$106.59
|
| Rate for Payer: Riverside University Health System MISP |
$50.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.70
|
| Rate for Payer: United Healthcare All Other HMO |
$62.70
|
| Rate for Payer: United Healthcare HMO Rider |
$62.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.59
|
| Rate for Payer: Vantage Medical Group Senior |
$106.59
|
|
|
HC DRAIN PVC 3/32X5IN CONSTAVAC
|
Facility
|
IP
|
$125.40
|
|
| Hospital Charge Code |
901602282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$112.86 |
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Central Health Plan Commercial |
$100.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.16
|
| Rate for Payer: Galaxy Health WC |
$106.59
|
| Rate for Payer: Global Benefits Group Commercial |
$75.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.08
|
| Rate for Payer: Multiplan Commercial |
$94.05
|
| Rate for Payer: Networks By Design Commercial |
$81.51
|
| Rate for Payer: Prime Health Services Commercial |
$106.59
|
|
|
HC DRAIN RESERVOIR BULB 100CC
|
Facility
|
OP
|
$1,168.40
|
|
| Hospital Charge Code |
901602740
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.68 |
| Max. Negotiated Rate |
$1,051.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$709.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$993.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$642.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$565.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$690.29
|
| Rate for Payer: Blue Distinction Transplant |
$701.04
|
| Rate for Payer: Blue Shield of California Commercial |
$734.92
|
| Rate for Payer: Blue Shield of California EPN |
$571.35
|
| Rate for Payer: Cash Price |
$525.78
|
| Rate for Payer: Central Health Plan Commercial |
$934.72
|
| Rate for Payer: Cigna of CA HMO |
$747.78
|
| Rate for Payer: Cigna of CA PPO |
$864.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$993.14
|
| Rate for Payer: Dignity Health Media |
$993.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$993.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$467.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$467.36
|
| Rate for Payer: Galaxy Health WC |
$993.14
|
| Rate for Payer: Global Benefits Group Commercial |
$701.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,051.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$876.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$408.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$779.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.68
|
| Rate for Payer: Multiplan Commercial |
$876.30
|
| Rate for Payer: Networks By Design Commercial |
$759.46
|
| Rate for Payer: Prime Health Services Commercial |
$993.14
|
| Rate for Payer: Riverside University Health System MISP |
$467.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$701.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$701.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$584.20
|
| Rate for Payer: United Healthcare All Other HMO |
$584.20
|
| Rate for Payer: United Healthcare HMO Rider |
$584.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$584.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$993.14
|
| Rate for Payer: Vantage Medical Group Senior |
$993.14
|
|
|
HC DRAIN RESERVOIR BULB 100CC
|
Facility
|
IP
|
$1,168.40
|
|
| Hospital Charge Code |
901602740
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.68 |
| Max. Negotiated Rate |
$1,051.56 |
| Rate for Payer: Cash Price |
$525.78
|
| Rate for Payer: Central Health Plan Commercial |
$934.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$467.36
|
| Rate for Payer: Galaxy Health WC |
$993.14
|
| Rate for Payer: Global Benefits Group Commercial |
$701.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,051.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$779.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.68
|
| Rate for Payer: Multiplan Commercial |
$876.30
|
| Rate for Payer: Networks By Design Commercial |
$759.46
|
| Rate for Payer: Prime Health Services Commercial |
$993.14
|
|
|
HC DRAIN ROUND 19FR W/TROCAR
|
Facility
|
IP
|
$80.28
|
|
| Hospital Charge Code |
901603855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Cash Price |
$36.13
|
| Rate for Payer: Central Health Plan Commercial |
$64.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.11
|
| Rate for Payer: Galaxy Health WC |
$68.24
|
| Rate for Payer: Global Benefits Group Commercial |
$48.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.06
|
| Rate for Payer: Multiplan Commercial |
$60.21
|
| Rate for Payer: Networks By Design Commercial |
$52.18
|
| Rate for Payer: Prime Health Services Commercial |
$68.24
|
|
|
HC DRAIN ROUND 19FR W/TROCAR
|
Facility
|
OP
|
$80.28
|
|
| Hospital Charge Code |
901603855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.43
|
| Rate for Payer: Blue Distinction Transplant |
$48.17
|
| Rate for Payer: Blue Shield of California Commercial |
$50.50
|
| Rate for Payer: Blue Shield of California EPN |
$39.26
|
| Rate for Payer: Cash Price |
$36.13
|
| Rate for Payer: Central Health Plan Commercial |
$64.22
|
| Rate for Payer: Cigna of CA HMO |
$51.38
|
| Rate for Payer: Cigna of CA PPO |
$59.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.24
|
| Rate for Payer: Dignity Health Media |
$68.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.11
|
| Rate for Payer: Galaxy Health WC |
$68.24
|
| Rate for Payer: Global Benefits Group Commercial |
$48.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$60.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.06
|
| Rate for Payer: Multiplan Commercial |
$60.21
|
| Rate for Payer: Networks By Design Commercial |
$52.18
|
| Rate for Payer: Prime Health Services Commercial |
$68.24
|
| Rate for Payer: Riverside University Health System MISP |
$32.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.14
|
| Rate for Payer: United Healthcare All Other HMO |
$40.14
|
| Rate for Payer: United Healthcare HMO Rider |
$40.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.24
|
| Rate for Payer: Vantage Medical Group Senior |
$68.24
|
|
|
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: Aetna of CA HMO/PPO |
$0.31
|
| 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 |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Distinction Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| 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 Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$0.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| 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: 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
|
| 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 Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
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: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 WOUND 1/8"
|
Facility
|
IP
|
$71.75
|
|
| Hospital Charge Code |
901605791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Cash Price |
$32.29
|
| Rate for Payer: Central Health Plan Commercial |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.70
|
| Rate for Payer: Galaxy Health WC |
$60.99
|
| Rate for Payer: Global Benefits Group Commercial |
$43.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.35
|
| Rate for Payer: Multiplan Commercial |
$53.81
|
| Rate for Payer: Networks By Design Commercial |
$46.64
|
| Rate for Payer: Prime Health Services Commercial |
$60.99
|
|
|
HC DRAIN WOUND 1/8"
|
Facility
|
OP
|
$71.75
|
|
| Hospital Charge Code |
901605791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$64.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.39
|
| Rate for Payer: Blue Distinction Transplant |
$43.05
|
| Rate for Payer: Blue Shield of California Commercial |
$45.13
|
| Rate for Payer: Blue Shield of California EPN |
$35.09
|
| Rate for Payer: Cash Price |
$32.29
|
| Rate for Payer: Central Health Plan Commercial |
$57.40
|
| Rate for Payer: Cigna of CA HMO |
$45.92
|
| Rate for Payer: Cigna of CA PPO |
$53.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.99
|
| Rate for Payer: Dignity Health Media |
$60.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.70
|
| Rate for Payer: Galaxy Health WC |
$60.99
|
| Rate for Payer: Global Benefits Group Commercial |
$43.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$53.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.35
|
| Rate for Payer: Multiplan Commercial |
$53.81
|
| Rate for Payer: Networks By Design Commercial |
$46.64
|
| Rate for Payer: Prime Health Services Commercial |
$60.99
|
| Rate for Payer: Riverside University Health System MISP |
$28.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.88
|
| Rate for Payer: United Healthcare All Other HMO |
$35.88
|
| Rate for Payer: United Healthcare HMO Rider |
$35.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.99
|
| Rate for Payer: Vantage Medical Group Senior |
$60.99
|
|
|
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: Cash Price |
$32.36
|
| Rate for Payer: Central Health Plan Commercial |
$57.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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: Aetna of CA HMO/PPO |
$43.13
|
| 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 |
$39.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.48
|
| Rate for Payer: Blue Distinction Transplant |
$43.15
|
| Rate for Payer: Blue Shield of California Commercial |
$45.23
|
| Rate for Payer: Blue Shield of California EPN |
$35.16
|
| Rate for Payer: Cash Price |
$32.36
|
| Rate for Payer: Cash Price |
$32.36
|
| 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 Media |
$61.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$53.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.17
|
| 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: 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
|
| 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 |
$35.96
|
| Rate for Payer: United Healthcare All Other HMO |
$35.96
|
| Rate for Payer: United Healthcare HMO Rider |
$35.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.96
|
| 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
|
IP
|
$17.22
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Cash Price |
$7.75
|
| Rate for Payer: Central Health Plan Commercial |
$13.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$14.64
|
| Rate for Payer: Global Benefits Group Commercial |
$10.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$12.92
|
| Rate for Payer: Networks By Design Commercial |
$11.19
|
| Rate for Payer: Prime Health Services Commercial |
$14.64
|
|
|
HC DRES HYDROGEL 4X4 CLEAR CARRADRES
|
Facility
|
OP
|
$17.22
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.17
|
| Rate for Payer: Blue Distinction Transplant |
$10.33
|
| Rate for Payer: Blue Shield of California Commercial |
$10.83
|
| Rate for Payer: Blue Shield of California EPN |
$8.42
|
| Rate for Payer: Cash Price |
$7.75
|
| Rate for Payer: Cash Price |
$7.75
|
| Rate for Payer: Central Health Plan Commercial |
$13.78
|
| Rate for Payer: Cigna of CA HMO |
$11.02
|
| Rate for Payer: Cigna of CA PPO |
$12.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.64
|
| Rate for Payer: Dignity Health Media |
$14.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$14.64
|
| Rate for Payer: Global Benefits Group Commercial |
$10.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$12.92
|
| Rate for Payer: Networks By Design Commercial |
$11.19
|
| Rate for Payer: Prime Health Services Commercial |
$14.64
|
| Rate for Payer: Riverside University Health System MISP |
$6.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.61
|
| Rate for Payer: United Healthcare All Other HMO |
$8.61
|
| Rate for Payer: United Healthcare HMO Rider |
$8.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.64
|
| Rate for Payer: Vantage Medical Group Senior |
$14.64
|
|
|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
OP
|
$1,939.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$6,248.00 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,163.40
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,551.20
|
| Rate for Payer: Cigna of CA PPO |
$1,434.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,648.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,745.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,454.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,454.25
|
| Rate for Payer: Networks By Design Commercial |
$1,260.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.15
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,163.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.50
|
| Rate for Payer: United Healthcare All Other HMO |
$969.50
|
| Rate for Payer: United Healthcare HMO Rider |
$969.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
IP
|
$1,939.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$1,745.10 |
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.60
|
| Rate for Payer: Galaxy Health WC |
$1,648.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,745.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$738.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.80
|
| Rate for Payer: Multiplan Commercial |
$1,454.25
|
| Rate for Payer: Networks By Design Commercial |
$1,260.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.15
|
|
|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
OP
|
$1,939.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,163.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,219.63
|
| Rate for Payer: Blue Shield of California EPN |
$948.17
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,551.20
|
| Rate for Payer: Cigna of CA HMO |
$1,240.96
|
| Rate for Payer: Cigna of CA PPO |
$1,434.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,648.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,745.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,454.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,454.25
|
| Rate for Payer: Networks By Design Commercial |
$1,260.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.15
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,163.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,163.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.50
|
| Rate for Payer: United Healthcare All Other HMO |
$969.50
|
| Rate for Payer: United Healthcare HMO Rider |
$969.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
IP
|
$1,939.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$1,745.10 |
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.60
|
| Rate for Payer: Galaxy Health WC |
$1,648.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,745.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$738.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.80
|
| Rate for Payer: Multiplan Commercial |
$1,454.25
|
| Rate for Payer: Networks By Design Commercial |
$1,260.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.15
|
|
|
HC DRES & OR DEB OF BURN INT/SUB MED
|
Facility
|
OP
|
$1,631.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$6,248.00 |
| 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 |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$978.60
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$733.95
|
| Rate for Payer: Cash Price |
$733.95
|
| Rate for Payer: Cash Price |
$733.95
|
| Rate for Payer: Cash Price |
$733.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,304.80
|
| Rate for Payer: Cigna of CA PPO |
$1,206.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,386.35
|
| Rate for Payer: Global Benefits Group Commercial |
$978.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,467.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,223.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,087.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,223.25
|
| Rate for Payer: Networks By Design Commercial |
$1,060.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,386.35
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$978.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.50
|
| Rate for Payer: United Healthcare All Other HMO |
$815.50
|
| Rate for Payer: United Healthcare HMO Rider |
$815.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC DRES & OR DEB OF BURN INT/SUB MED
|
Facility
|
IP
|
$1,631.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$326.20 |
| Max. Negotiated Rate |
$1,467.90 |
| Rate for Payer: Cash Price |
$733.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,304.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.40
|
| Rate for Payer: Galaxy Health WC |
$1,386.35
|
| Rate for Payer: Global Benefits Group Commercial |
$978.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,467.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,087.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$621.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.20
|
| Rate for Payer: Multiplan Commercial |
$1,223.25
|
| Rate for Payer: Networks By Design Commercial |
$1,060.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,386.35
|
|
|
HC DRES & OR DEB OF BURN INT/SUB MED
|
Facility
|
IP
|
$1,631.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$326.20 |
| Max. Negotiated Rate |
$1,467.90 |
| Rate for Payer: Cash Price |
$733.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,304.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.40
|
| Rate for Payer: Galaxy Health WC |
$1,386.35
|
| Rate for Payer: Global Benefits Group Commercial |
$978.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,467.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,087.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$621.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.20
|
| Rate for Payer: Multiplan Commercial |
$1,223.25
|
| Rate for Payer: Networks By Design Commercial |
$1,060.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,386.35
|
|
|
HC DRES & OR DEB OF BURN INT/SUB MED
|
Facility
|
OP
|
$1,631.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
900501047
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$978.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,025.90
|
| Rate for Payer: Blue Shield of California EPN |
$797.56
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$733.95
|
| Rate for Payer: Cash Price |
$733.95
|
| Rate for Payer: Cash Price |
$733.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,304.80
|
| Rate for Payer: Cigna of CA HMO |
$1,043.84
|
| Rate for Payer: Cigna of CA PPO |
$1,206.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$1,386.35
|
| Rate for Payer: Global Benefits Group Commercial |
$978.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,467.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,223.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,087.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$1,223.25
|
| Rate for Payer: Networks By Design Commercial |
$1,060.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,386.35
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$978.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$978.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.50
|
| Rate for Payer: United Healthcare All Other HMO |
$815.50
|
| Rate for Payer: United Healthcare HMO Rider |
$815.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC DRES & OR DEB OF BURN INT/SUB SMALL
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
900501046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.14 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$690.00
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Central Health Plan Commercial |
$920.00
|
| Rate for Payer: Cigna of CA PPO |
$851.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$862.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$690.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$575.00
|
| Rate for Payer: United Healthcare All Other HMO |
$575.00
|
| Rate for Payer: United Healthcare HMO Rider |
$575.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC DRES & OR DEB OF BURN INT/SUB SMALL
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
900501046
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Central Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
|
