|
HC DRSNG WOUND VAC ATS SMALL
|
Facility
|
OP
|
$230.30
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604212
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$207.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.06
|
| Rate for Payer: Blue Distinction Transplant |
$138.18
|
| Rate for Payer: Blue Shield of California Commercial |
$144.86
|
| Rate for Payer: Blue Shield of California EPN |
$112.62
|
| Rate for Payer: Cash Price |
$103.64
|
| Rate for Payer: Cash Price |
$103.64
|
| Rate for Payer: Central Health Plan Commercial |
$184.24
|
| Rate for Payer: Cigna of CA HMO |
$147.39
|
| Rate for Payer: Cigna of CA PPO |
$170.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.76
|
| Rate for Payer: Dignity Health Media |
$195.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$92.12
|
| Rate for Payer: Galaxy Health WC |
$195.76
|
| Rate for Payer: Global Benefits Group Commercial |
$138.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$172.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.06
|
| Rate for Payer: Multiplan Commercial |
$172.72
|
| Rate for Payer: Networks By Design Commercial |
$149.70
|
| Rate for Payer: Prime Health Services Commercial |
$195.76
|
| Rate for Payer: Riverside University Health System MISP |
$92.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.15
|
| Rate for Payer: United Healthcare All Other HMO |
$115.15
|
| Rate for Payer: United Healthcare HMO Rider |
$115.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.76
|
| Rate for Payer: Vantage Medical Group Senior |
$195.76
|
|
|
HC DRSNG WOUND VAC LG
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC DRSNG WOUND VAC LG
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604843
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC DRSNG WOUND VAC MED BLACK
|
Facility
|
IP
|
$284.55
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.91 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Central Health Plan Commercial |
$227.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.82
|
| Rate for Payer: Galaxy Health WC |
$241.87
|
| Rate for Payer: Global Benefits Group Commercial |
$170.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.91
|
| Rate for Payer: Multiplan Commercial |
$213.41
|
| Rate for Payer: Networks By Design Commercial |
$184.96
|
| Rate for Payer: Prime Health Services Commercial |
$241.87
|
|
|
HC DRSNG WOUND VAC MED BLACK
|
Facility
|
OP
|
$284.55
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$241.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$137.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.11
|
| Rate for Payer: Blue Distinction Transplant |
$170.73
|
| Rate for Payer: Blue Shield of California Commercial |
$178.98
|
| Rate for Payer: Blue Shield of California EPN |
$139.14
|
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Cash Price |
$128.05
|
| Rate for Payer: Central Health Plan Commercial |
$227.64
|
| Rate for Payer: Cigna of CA HMO |
$182.11
|
| Rate for Payer: Cigna of CA PPO |
$210.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.87
|
| Rate for Payer: Dignity Health Media |
$241.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.82
|
| Rate for Payer: Galaxy Health WC |
$241.87
|
| Rate for Payer: Global Benefits Group Commercial |
$170.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$213.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.91
|
| Rate for Payer: Multiplan Commercial |
$213.41
|
| Rate for Payer: Networks By Design Commercial |
$184.96
|
| Rate for Payer: Prime Health Services Commercial |
$241.87
|
| Rate for Payer: Riverside University Health System MISP |
$113.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.28
|
| Rate for Payer: United Healthcare All Other HMO |
$142.28
|
| Rate for Payer: United Healthcare HMO Rider |
$142.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.87
|
| Rate for Payer: Vantage Medical Group Senior |
$241.87
|
|
|
HC DRSNG WOUND VAC MED SLVR
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901609001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC DRSNG WOUND VAC MED SLVR
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901609001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC DRSNG WOUND VAC THIN
|
Facility
|
OP
|
$364.82
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$328.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$176.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.54
|
| Rate for Payer: Blue Distinction Transplant |
$218.89
|
| Rate for Payer: Blue Shield of California Commercial |
$229.47
|
| Rate for Payer: Blue Shield of California EPN |
$178.40
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Central Health Plan Commercial |
$291.86
|
| Rate for Payer: Cigna of CA HMO |
$233.48
|
| Rate for Payer: Cigna of CA PPO |
$269.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.10
|
| Rate for Payer: Dignity Health Media |
$310.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$145.93
|
| Rate for Payer: Galaxy Health WC |
$310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$218.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$273.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$127.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.96
|
| Rate for Payer: Multiplan Commercial |
$273.62
|
| Rate for Payer: Networks By Design Commercial |
$237.13
|
| Rate for Payer: Prime Health Services Commercial |
$310.10
|
| Rate for Payer: Riverside University Health System MISP |
$145.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$218.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$218.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.41
|
| Rate for Payer: United Healthcare All Other HMO |
$182.41
|
| Rate for Payer: United Healthcare HMO Rider |
$182.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$182.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.10
|
| Rate for Payer: Vantage Medical Group Senior |
$310.10
|
|
|
HC DRSNG WOUND VAC THIN
|
Facility
|
IP
|
$364.82
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901604837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$328.34 |
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Central Health Plan Commercial |
$291.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.93
|
| Rate for Payer: Galaxy Health WC |
$310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$218.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.96
|
| Rate for Payer: Multiplan Commercial |
$273.62
|
| Rate for Payer: Networks By Design Commercial |
$237.13
|
| Rate for Payer: Prime Health Services Commercial |
$310.10
|
|
|
HC DRSNG WOUND VAC VERAFLO LRG
|
Facility
|
IP
|
$1,012.69
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.54 |
| Max. Negotiated Rate |
$911.42 |
| Rate for Payer: Cash Price |
$455.71
|
| Rate for Payer: Central Health Plan Commercial |
$810.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.08
|
| Rate for Payer: Galaxy Health WC |
$860.79
|
| Rate for Payer: Global Benefits Group Commercial |
$607.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.54
|
| Rate for Payer: Multiplan Commercial |
$759.52
|
| Rate for Payer: Networks By Design Commercial |
$658.25
|
| Rate for Payer: Prime Health Services Commercial |
$860.79
|
|
|
HC DRSNG WOUND VAC VERAFLO LRG
|
Facility
|
OP
|
$1,012.69
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$911.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$556.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.30
|
| Rate for Payer: Blue Distinction Transplant |
$607.61
|
| Rate for Payer: Blue Shield of California Commercial |
$636.98
|
| Rate for Payer: Blue Shield of California EPN |
$495.21
|
| Rate for Payer: Cash Price |
$455.71
|
| Rate for Payer: Cash Price |
$455.71
|
| Rate for Payer: Central Health Plan Commercial |
$810.15
|
| Rate for Payer: Cigna of CA HMO |
$648.12
|
| Rate for Payer: Cigna of CA PPO |
$749.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.79
|
| Rate for Payer: Dignity Health Media |
$860.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$405.08
|
| Rate for Payer: Galaxy Health WC |
$860.79
|
| Rate for Payer: Global Benefits Group Commercial |
$607.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$759.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.54
|
| Rate for Payer: Multiplan Commercial |
$759.52
|
| Rate for Payer: Networks By Design Commercial |
$658.25
|
| Rate for Payer: Prime Health Services Commercial |
$860.79
|
| Rate for Payer: Riverside University Health System MISP |
$405.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.34
|
| Rate for Payer: United Healthcare All Other HMO |
$506.34
|
| Rate for Payer: United Healthcare HMO Rider |
$506.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.79
|
| Rate for Payer: Vantage Medical Group Senior |
$860.79
|
|
|
HC DRSNG WOUND VAC VERAFLO MED
|
Facility
|
OP
|
$944.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$850.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$802.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$519.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$519.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$457.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$558.05
|
| Rate for Payer: Blue Distinction Transplant |
$566.74
|
| Rate for Payer: Blue Shield of California Commercial |
$594.13
|
| Rate for Payer: Blue Shield of California EPN |
$461.89
|
| Rate for Payer: Cash Price |
$425.05
|
| Rate for Payer: Cash Price |
$425.05
|
| Rate for Payer: Central Health Plan Commercial |
$755.65
|
| Rate for Payer: Cigna of CA HMO |
$604.52
|
| Rate for Payer: Cigna of CA PPO |
$698.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$802.88
|
| Rate for Payer: Dignity Health Media |
$802.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$802.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$377.82
|
| Rate for Payer: Galaxy Health WC |
$802.88
|
| Rate for Payer: Global Benefits Group Commercial |
$566.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$850.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$708.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$330.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.91
|
| Rate for Payer: Multiplan Commercial |
$708.42
|
| Rate for Payer: Networks By Design Commercial |
$613.96
|
| Rate for Payer: Prime Health Services Commercial |
$802.88
|
| Rate for Payer: Riverside University Health System MISP |
$377.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$566.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$566.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$472.28
|
| Rate for Payer: United Healthcare All Other HMO |
$472.28
|
| Rate for Payer: United Healthcare HMO Rider |
$472.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$472.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$802.88
|
| Rate for Payer: Vantage Medical Group Senior |
$802.88
|
|
|
HC DRSNG WOUND VAC VERAFLO MED
|
Facility
|
IP
|
$944.56
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698622
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.91 |
| Max. Negotiated Rate |
$850.10 |
| Rate for Payer: Cash Price |
$425.05
|
| Rate for Payer: Central Health Plan Commercial |
$755.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.82
|
| Rate for Payer: Galaxy Health WC |
$802.88
|
| Rate for Payer: Global Benefits Group Commercial |
$566.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$850.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.91
|
| Rate for Payer: Multiplan Commercial |
$708.42
|
| Rate for Payer: Networks By Design Commercial |
$613.96
|
| Rate for Payer: Prime Health Services Commercial |
$802.88
|
|
|
HC DRSNG WOUND VAC WHITE LG
|
Facility
|
IP
|
$93.02
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$83.72 |
| Rate for Payer: Cash Price |
$41.86
|
| Rate for Payer: Central Health Plan Commercial |
$74.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.21
|
| Rate for Payer: Galaxy Health WC |
$79.07
|
| Rate for Payer: Global Benefits Group Commercial |
$55.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.76
|
| Rate for Payer: Networks By Design Commercial |
$60.46
|
| Rate for Payer: Prime Health Services Commercial |
$79.07
|
|
|
HC DRSNG WOUND VAC WHITE LG
|
Facility
|
OP
|
$93.02
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$83.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.96
|
| Rate for Payer: Blue Distinction Transplant |
$55.81
|
| Rate for Payer: Blue Shield of California Commercial |
$58.51
|
| Rate for Payer: Blue Shield of California EPN |
$45.49
|
| Rate for Payer: Cash Price |
$41.86
|
| Rate for Payer: Cash Price |
$41.86
|
| Rate for Payer: Central Health Plan Commercial |
$74.42
|
| Rate for Payer: Cigna of CA HMO |
$59.53
|
| Rate for Payer: Cigna of CA PPO |
$68.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.07
|
| Rate for Payer: Dignity Health Media |
$79.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.21
|
| Rate for Payer: Galaxy Health WC |
$79.07
|
| Rate for Payer: Global Benefits Group Commercial |
$55.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$83.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$69.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$69.76
|
| Rate for Payer: Networks By Design Commercial |
$60.46
|
| Rate for Payer: Prime Health Services Commercial |
$79.07
|
| Rate for Payer: Riverside University Health System MISP |
$37.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.51
|
| Rate for Payer: United Healthcare All Other HMO |
$46.51
|
| Rate for Payer: United Healthcare HMO Rider |
$46.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.07
|
| Rate for Payer: Vantage Medical Group Senior |
$79.07
|
|
|
HC DRSNG WOUND VAC WHITE SM
|
Facility
|
IP
|
$78.47
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$70.62 |
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: Central Health Plan Commercial |
$62.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.39
|
| Rate for Payer: Galaxy Health WC |
$66.70
|
| Rate for Payer: Global Benefits Group Commercial |
$47.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.69
|
| Rate for Payer: Multiplan Commercial |
$58.85
|
| Rate for Payer: Networks By Design Commercial |
$51.01
|
| Rate for Payer: Prime Health Services Commercial |
$66.70
|
|
|
HC DRSNG WOUND VAC WHITE SM
|
Facility
|
OP
|
$78.47
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901605219
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$70.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.36
|
| Rate for Payer: Blue Distinction Transplant |
$47.08
|
| Rate for Payer: Blue Shield of California Commercial |
$49.36
|
| Rate for Payer: Blue Shield of California EPN |
$38.37
|
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: Central Health Plan Commercial |
$62.78
|
| Rate for Payer: Cigna of CA HMO |
$50.22
|
| Rate for Payer: Cigna of CA PPO |
$58.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.70
|
| Rate for Payer: Dignity Health Media |
$66.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.39
|
| Rate for Payer: Galaxy Health WC |
$66.70
|
| Rate for Payer: Global Benefits Group Commercial |
$47.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.62
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$58.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.69
|
| Rate for Payer: Multiplan Commercial |
$58.85
|
| Rate for Payer: Networks By Design Commercial |
$51.01
|
| Rate for Payer: Prime Health Services Commercial |
$66.70
|
| Rate for Payer: Riverside University Health System MISP |
$31.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.24
|
| Rate for Payer: United Healthcare All Other HMO |
$39.24
|
| Rate for Payer: United Healthcare HMO Rider |
$39.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.70
|
| Rate for Payer: Vantage Medical Group Senior |
$66.70
|
|
|
HC DRSNG XERFORM ROLL 4"X3YD
|
Facility
|
IP
|
$23.37
|
|
|
Service Code
|
CPT A6224
|
| Hospital Charge Code |
901695706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: Central Health Plan Commercial |
$18.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.35
|
| Rate for Payer: Galaxy Health WC |
$19.86
|
| Rate for Payer: Global Benefits Group Commercial |
$14.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.67
|
| Rate for Payer: Multiplan Commercial |
$17.53
|
| Rate for Payer: Networks By Design Commercial |
$15.19
|
| Rate for Payer: Prime Health Services Commercial |
$19.86
|
|
|
HC DRSNG XERFORM ROLL 4"X3YD
|
Facility
|
OP
|
$23.37
|
|
|
Service Code
|
CPT A6224
|
| Hospital Charge Code |
901695706
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$21.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.81
|
| Rate for Payer: Blue Distinction Transplant |
$14.02
|
| Rate for Payer: Blue Shield of California Commercial |
$14.70
|
| Rate for Payer: Blue Shield of California EPN |
$11.43
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: Cash Price |
$10.52
|
| Rate for Payer: Central Health Plan Commercial |
$18.70
|
| Rate for Payer: Cigna of CA HMO |
$14.96
|
| Rate for Payer: Cigna of CA PPO |
$17.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Media |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.35
|
| Rate for Payer: Galaxy Health WC |
$19.86
|
| Rate for Payer: Global Benefits Group Commercial |
$14.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.67
|
| Rate for Payer: Multiplan Commercial |
$17.53
|
| Rate for Payer: Networks By Design Commercial |
$15.19
|
| Rate for Payer: Prime Health Services Commercial |
$19.86
|
| Rate for Payer: Riverside University Health System MISP |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.68
|
| Rate for Payer: United Healthcare All Other HMO |
$11.68
|
| Rate for Payer: United Healthcare HMO Rider |
$11.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Vantage Medical Group Senior |
$19.86
|
|
|
HC DRUGS ABUSE SCREEN,URINE(7)COC
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$765.90 |
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Central Health Plan Commercial |
$680.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.20
|
| Rate for Payer: Multiplan Commercial |
$638.25
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
|
|
HC DRUGS ABUSE SCREEN,URINE(7)COC
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$546.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.80
|
| Rate for Payer: Blue Distinction Transplant |
$63.00
|
| Rate for Payer: Blue Shield of California Commercial |
$64.89
|
| Rate for Payer: Blue Shield of California EPN |
$51.03
|
| Rate for Payer: Caremore Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Media |
$62.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$78.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN AMPHETAMINES
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC DRUG SCREEN AMPHETAMINES
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911077
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$546.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.80
|
| Rate for Payer: Blue Distinction Transplant |
$63.00
|
| Rate for Payer: Blue Shield of California Commercial |
$64.89
|
| Rate for Payer: Blue Shield of California EPN |
$51.03
|
| Rate for Payer: Caremore Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Media |
$62.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$78.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN BARBITUATES
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910325
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$546.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.80
|
| Rate for Payer: Blue Distinction Transplant |
$63.00
|
| Rate for Payer: Blue Shield of California Commercial |
$64.89
|
| Rate for Payer: Blue Shield of California EPN |
$51.03
|
| Rate for Payer: Caremore Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Media |
$62.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$78.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC DRUG SCREEN BARBITUATES
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910325
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
