|
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: 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
|
|
|
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 |
$230.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$862.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: 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 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: Redlands Yucaipa Medical Group Commercial/Senior |
$690.00
|
| Rate for Payer: Riverside University Health 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 DRESSING CHANGE UNDER ANESTH
|
Facility
OP
|
$656.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.20 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| 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: BCBS Transplant Transplant |
$393.60
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Central Health Plan Commercial |
$524.80
|
| Rate for Payer: Cigna of CA PPO |
$485.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$557.60
|
| Rate for Payer: Global Benefits Group Commercial |
$393.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$590.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$492.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Innovage PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$437.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: Networks By Design Commercial |
$426.40
|
| Rate for Payer: Prime Health Services Commercial |
$557.60
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$393.60
|
| Rate for Payer: Riverside University Health MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$393.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.00
|
| Rate for Payer: United Healthcare All Other HMO |
$328.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC DRESSING CHANGE UNDER ANESTH
|
Facility
IP
|
$656.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$590.40 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Central Health Plan Commercial |
$524.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.40
|
| Rate for Payer: Galaxy Health WC |
$557.60
|
| Rate for Payer: Global Benefits Group Commercial |
$393.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$590.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$437.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.20
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: Networks By Design Commercial |
$426.40
|
| Rate for Payer: Prime Health Services Commercial |
$557.60
|
|
|
HC DRESSING CHANGE UNDER ANESTH
|
Facility
OP
|
$656.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$393.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Central Health Plan Commercial |
$524.80
|
| Rate for Payer: Cigna of CA PPO |
$485.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$557.60
|
| Rate for Payer: Global Benefits Group Commercial |
$393.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$590.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$492.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: IEHP medi-cal |
$1,294.77
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Innovage PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$437.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: Networks By Design Commercial |
$426.40
|
| Rate for Payer: Prime Health Services Commercial |
$557.60
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$393.60
|
| Rate for Payer: Riverside University Health MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$393.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC DRESSING CHANGE UNDER ANESTH
|
Facility
IP
|
$656.00
|
|
|
Service Code
|
CPT 15852
|
| Hospital Charge Code |
907201139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$590.40 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Central Health Plan Commercial |
$524.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.40
|
| Rate for Payer: Galaxy Health WC |
$557.60
|
| Rate for Payer: Global Benefits Group Commercial |
$393.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$590.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$437.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.20
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: Networks By Design Commercial |
$426.40
|
| Rate for Payer: Prime Health Services Commercial |
$557.60
|
|
|
HC DRESSING EXUFIBER 6X6"
|
Facility
OP
|
$48.05
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$43.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.39
|
| Rate for Payer: BCBS Transplant Transplant |
$28.83
|
| Rate for Payer: Blue Shield of California Commercial |
$30.22
|
| Rate for Payer: Blue Shield of California EPN |
$23.50
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Central Health Plan Commercial |
$38.44
|
| Rate for Payer: Cigna of CA HMO |
$30.75
|
| Rate for Payer: Cigna of CA PPO |
$35.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.22
|
| Rate for Payer: Galaxy Health WC |
$40.84
|
| Rate for Payer: Global Benefits Group Commercial |
$28.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$36.04
|
| Rate for Payer: IEHP medi-cal |
$16.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.61
|
| Rate for Payer: Multiplan Commercial |
$36.04
|
| Rate for Payer: Networks By Design Commercial |
$31.23
|
| Rate for Payer: Prime Health Services Commercial |
$40.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$28.83
|
| Rate for Payer: Riverside University Health MISP |
$19.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.02
|
| Rate for Payer: United Healthcare All Other HMO |
$24.02
|
| Rate for Payer: United Healthcare HMO Rider |
$24.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.84
|
| Rate for Payer: Vantage Medical Group Senior |
$40.84
|
|
|
HC DRESSING EXUFIBER 6X6"
|
Facility
IP
|
$48.05
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$43.24 |
| Rate for Payer: Cash Price |
$21.62
|
| Rate for Payer: Central Health Plan Commercial |
$38.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.22
|
| Rate for Payer: Galaxy Health WC |
$40.84
|
| Rate for Payer: Global Benefits Group Commercial |
$28.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.61
|
| Rate for Payer: Multiplan Commercial |
$36.04
|
| Rate for Payer: Networks By Design Commercial |
$31.23
|
| Rate for Payer: Prime Health Services Commercial |
$40.84
|
|
|
HC DRESSING EXUFIBER AG 6X6"
|
Facility
OP
|
$102.22
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$86.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$56.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$56.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.39
|
| Rate for Payer: BCBS Transplant Transplant |
$61.33
|
| Rate for Payer: Blue Shield of California Commercial |
$64.30
|
| Rate for Payer: Blue Shield of California EPN |
$49.99
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Central Health Plan Commercial |
$81.78
|
| Rate for Payer: Cigna of CA HMO |
$65.42
|
| Rate for Payer: Cigna of CA PPO |
$75.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.89
|
| Rate for Payer: Galaxy Health WC |
$86.89
|
| Rate for Payer: Global Benefits Group Commercial |
$61.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$76.66
|
| Rate for Payer: IEHP medi-cal |
$35.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.44
|
| Rate for Payer: Multiplan Commercial |
$76.66
|
| Rate for Payer: Networks By Design Commercial |
$66.44
|
| Rate for Payer: Prime Health Services Commercial |
$86.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$61.33
|
| Rate for Payer: Riverside University Health MISP |
$40.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.11
|
| Rate for Payer: United Healthcare All Other HMO |
$51.11
|
| Rate for Payer: United Healthcare HMO Rider |
$51.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.89
|
| Rate for Payer: Vantage Medical Group Senior |
$86.89
|
|
|
HC DRESSING EXUFIBER AG 6X6"
|
Facility
IP
|
$102.22
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Central Health Plan Commercial |
$81.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.89
|
| Rate for Payer: Galaxy Health WC |
$86.89
|
| Rate for Payer: Global Benefits Group Commercial |
$61.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.44
|
| Rate for Payer: Multiplan Commercial |
$76.66
|
| Rate for Payer: Networks By Design Commercial |
$66.44
|
| Rate for Payer: Prime Health Services Commercial |
$86.89
|
|
|
HC DRESSING EXUFIBER AG 8X12"
|
Facility
IP
|
$16.07
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901698257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Networks By Design Commercial |
$10.45
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
|
|
HC DRESSING EXUFIBER AG 8X12"
|
Facility
OP
|
$16.07
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901698257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$122.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.49
|
| Rate for Payer: BCBS Transplant Transplant |
$9.64
|
| Rate for Payer: Blue Shield of California Commercial |
$10.11
|
| Rate for Payer: Blue Shield of California EPN |
$7.86
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: Cigna of CA HMO |
$10.28
|
| Rate for Payer: Cigna of CA PPO |
$11.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.05
|
| Rate for Payer: IEHP medi-cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Networks By Design Commercial |
$10.45
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.64
|
| Rate for Payer: Riverside University Health MISP |
$6.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.04
|
| Rate for Payer: United Healthcare All Other HMO |
$8.04
|
| Rate for Payer: United Healthcare HMO Rider |
$8.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.66
|
| Rate for Payer: Vantage Medical Group Senior |
$13.66
|
|
|
HC DRESSING HYDROFERA FOAM 8X8"
|
Facility
OP
|
$109.59
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$98.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$93.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$60.27
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$60.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.75
|
| Rate for Payer: BCBS Transplant Transplant |
$65.75
|
| Rate for Payer: Blue Shield of California Commercial |
$68.93
|
| Rate for Payer: Blue Shield of California EPN |
$53.59
|
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Central Health Plan Commercial |
$87.67
|
| Rate for Payer: Cigna of CA HMO |
$70.14
|
| Rate for Payer: Cigna of CA PPO |
$81.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$43.84
|
| Rate for Payer: Galaxy Health WC |
$93.15
|
| Rate for Payer: Global Benefits Group Commercial |
$65.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$82.19
|
| Rate for Payer: IEHP medi-cal |
$38.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.92
|
| Rate for Payer: Multiplan Commercial |
$82.19
|
| Rate for Payer: Networks By Design Commercial |
$71.23
|
| Rate for Payer: Prime Health Services Commercial |
$93.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$65.75
|
| Rate for Payer: Riverside University Health MISP |
$43.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.80
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$54.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.15
|
| Rate for Payer: Vantage Medical Group Senior |
$93.15
|
|
|
HC DRESSING HYDROFERA FOAM 8X8"
|
Facility
IP
|
$109.59
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$98.63 |
| Rate for Payer: Cash Price |
$49.32
|
| Rate for Payer: Central Health Plan Commercial |
$87.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.84
|
| Rate for Payer: Galaxy Health WC |
$93.15
|
| Rate for Payer: Global Benefits Group Commercial |
$65.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.92
|
| Rate for Payer: Multiplan Commercial |
$82.19
|
| Rate for Payer: Networks By Design Commercial |
$71.23
|
| Rate for Payer: Prime Health Services Commercial |
$93.15
|
|
|
HC DRESSING MEPITEL ONE 2X3"
|
Facility
IP
|
$25.26
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901607884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Central Health Plan Commercial |
$20.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$18.94
|
| Rate for Payer: Networks By Design Commercial |
$16.42
|
| Rate for Payer: Prime Health Services Commercial |
$21.47
|
|
|
HC DRESSING MEPITEL ONE 2X3"
|
Facility
OP
|
$25.26
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901607884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.92
|
| Rate for Payer: BCBS Transplant Transplant |
$15.16
|
| Rate for Payer: Blue Shield of California Commercial |
$15.89
|
| Rate for Payer: Blue Shield of California EPN |
$12.35
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Central Health Plan Commercial |
$20.21
|
| Rate for Payer: Cigna of CA HMO |
$16.17
|
| Rate for Payer: Cigna of CA PPO |
$18.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.94
|
| Rate for Payer: IEHP medi-cal |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$18.94
|
| Rate for Payer: Networks By Design Commercial |
$16.42
|
| Rate for Payer: Prime Health Services Commercial |
$21.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.16
|
| Rate for Payer: Riverside University Health MISP |
$10.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.63
|
| Rate for Payer: United Healthcare All Other HMO |
$12.63
|
| Rate for Payer: United Healthcare HMO Rider |
$12.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.47
|
| Rate for Payer: Vantage Medical Group Senior |
$21.47
|
|
|
HC DRES TEGADERM 8X6" TRANSPARENT FRAME STYLE
|
Facility
IP
|
$9.76
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901605554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Central Health Plan Commercial |
$7.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$7.32
|
| Rate for Payer: Networks By Design Commercial |
$6.34
|
| Rate for Payer: Prime Health Services Commercial |
$8.30
|
|
|
HC DRES TEGADERM 8X6" TRANSPARENT FRAME STYLE
|
Facility
OP
|
$9.76
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901605554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.77
|
| Rate for Payer: BCBS Transplant Transplant |
$5.86
|
| Rate for Payer: Blue Shield of California Commercial |
$6.14
|
| Rate for Payer: Blue Shield of California EPN |
$4.77
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Central Health Plan Commercial |
$7.81
|
| Rate for Payer: Cigna of CA HMO |
$6.25
|
| Rate for Payer: Cigna of CA PPO |
$7.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.32
|
| Rate for Payer: IEHP medi-cal |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$7.32
|
| Rate for Payer: Networks By Design Commercial |
$6.34
|
| Rate for Payer: Prime Health Services Commercial |
$8.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.86
|
| Rate for Payer: Riverside University Health MISP |
$3.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.88
|
| Rate for Payer: United Healthcare All Other HMO |
$4.88
|
| Rate for Payer: United Healthcare HMO Rider |
$4.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8.30
|
|
|
HC DRES THERAHONEY 1.5 OZ TUBE
|
Facility
IP
|
$83.52
|
|
| Hospital Charge Code |
901698131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$75.17 |
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Central Health Plan Commercial |
$66.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.41
|
| Rate for Payer: Galaxy Health WC |
$70.99
|
| Rate for Payer: Global Benefits Group Commercial |
$50.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$62.64
|
| Rate for Payer: Networks By Design Commercial |
$54.29
|
| Rate for Payer: Prime Health Services Commercial |
$70.99
|
|
|
HC DRES THERAHONEY 1.5 OZ TUBE
|
Facility
OP
|
$83.52
|
|
| Hospital Charge Code |
901698131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$75.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$70.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.94
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.34
|
| Rate for Payer: BCBS Transplant Transplant |
$50.11
|
| Rate for Payer: Blue Shield of California Commercial |
$52.53
|
| Rate for Payer: Blue Shield of California EPN |
$40.84
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Central Health Plan Commercial |
$66.82
|
| Rate for Payer: Cigna of CA HMO |
$53.45
|
| Rate for Payer: Cigna of CA PPO |
$61.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.41
|
| Rate for Payer: Galaxy Health WC |
$70.99
|
| Rate for Payer: Global Benefits Group Commercial |
$50.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.17
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$62.64
|
| Rate for Payer: IEHP medi-cal |
$29.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$62.64
|
| Rate for Payer: Networks By Design Commercial |
$54.29
|
| Rate for Payer: Prime Health Services Commercial |
$70.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$50.11
|
| Rate for Payer: Riverside University Health MISP |
$33.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.76
|
| Rate for Payer: United Healthcare All Other HMO |
$41.76
|
| Rate for Payer: United Healthcare HMO Rider |
$41.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.99
|
| Rate for Payer: Vantage Medical Group Senior |
$70.99
|
|
|
HC DRIED BLOOD SPOT SCREEN DUKE
|
Facility
IP
|
$232.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC DRIED BLOOD SPOT SCREEN DUKE
|
Facility
OP
|
$232.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.07
|
| Rate for Payer: BCBS Transplant Transplant |
$139.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.38
|
| Rate for Payer: Blue Shield of California EPN |
$112.75
|
| Rate for Payer: Caremore Medicare Advantage |
$8.10
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: Cigna of CA HMO |
$148.48
|
| Rate for Payer: Cigna of CA PPO |
$171.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$174.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.28
|
| Rate for Payer: IEHP medi-cal |
$13.36
|
| Rate for Payer: IEHP Medicare Advantage |
$8.10
|
| Rate for Payer: Innovage PACE Commercial |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
| Rate for Payer: Prime Health Services Medicare |
$8.59
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: Riverside University Health MISP |
$8.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC DRILL SKULL FOR IMPLANTATION
|
Facility
IP
|
$8,704.00
|
|
|
Service Code
|
CPT 61107
|
| Hospital Charge Code |
900501647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,740.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,963.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,481.60
|
| Rate for Payer: Galaxy Health WC |
$7,398.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,222.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,833.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,805.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.80
|
| Rate for Payer: Multiplan Commercial |
$6,528.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,398.40
|
|
|
HC DRILL SKULL FOR IMPLANTATION
|
Facility
OP
|
$8,704.00
|
|
|
Service Code
|
CPT 61107
|
| Hospital Charge Code |
900501647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,597.25 |
| Max. Negotiated Rate |
$7,833.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,597.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,398.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,787.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,787.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,222.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,963.20
|
| Rate for Payer: Cigna of CA PPO |
$6,440.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,398.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,481.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,481.60
|
| Rate for Payer: Galaxy Health WC |
$7,398.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,222.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,833.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,528.00
|
| Rate for Payer: IEHP medi-cal |
$3,046.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,805.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,740.80
|
| Rate for Payer: Multiplan Commercial |
$6,528.00
|
| Rate for Payer: Networks By Design Commercial |
$5,657.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,398.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,222.40
|
| Rate for Payer: Riverside University Health MISP |
$3,481.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,222.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,398.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7,398.40
|
|
|
HC DROP LOCK RETAINER PER BAR
|
Facility
IP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
905352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Blue Shield of California EPN |
$25.10
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
|
