|
HC SKIN PRO PASTE PHYTOPLEX 2 OZ
|
Facility
|
OP
|
$20.25
|
|
| Hospital Charge Code |
901698704
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.78
|
| Rate for Payer: Blue Shield of California Commercial |
$12.84
|
| Rate for Payer: Blue Shield of California EPN |
$8.08
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Central Health Plan Commercial |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$12.96
|
| Rate for Payer: Cigna of CA PPO |
$14.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$15.19
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
| Rate for Payer: Riverside University Health System MISP |
$8.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.12
|
| Rate for Payer: United Healthcare All Other HMO |
$10.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.21
|
| Rate for Payer: Vantage Medical Group Senior |
$17.21
|
|
|
HC SKIN PROTECTANT CAVILON 0.7ML
|
Facility
|
IP
|
$45.92
|
|
| Hospital Charge Code |
901698453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$41.33 |
| Rate for Payer: Adventist Health Commercial |
$9.18
|
| Rate for Payer: Cash Price |
$20.66
|
| Rate for Payer: Central Health Plan Commercial |
$36.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$39.03
|
| Rate for Payer: Global Benefits Group Commercial |
$27.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.18
|
| Rate for Payer: Multiplan Commercial |
$34.44
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.03
|
|
|
HC SKIN PROTECTANT CAVILON 0.7ML
|
Facility
|
OP
|
$45.92
|
|
| Hospital Charge Code |
901698453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$41.33 |
| Rate for Payer: Adventist Health Commercial |
$9.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.71
|
| Rate for Payer: Blue Shield of California Commercial |
$29.11
|
| Rate for Payer: Blue Shield of California EPN |
$18.32
|
| Rate for Payer: Cash Price |
$20.66
|
| Rate for Payer: Central Health Plan Commercial |
$36.74
|
| Rate for Payer: Cigna of CA HMO |
$29.39
|
| Rate for Payer: Cigna of CA PPO |
$33.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$39.03
|
| Rate for Payer: Global Benefits Group Commercial |
$27.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.14
|
| Rate for Payer: Multiplan Commercial |
$34.44
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.03
|
| Rate for Payer: Riverside University Health System MISP |
$18.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.96
|
| Rate for Payer: United Healthcare All Other HMO |
$22.96
|
| Rate for Payer: United Healthcare HMO Rider |
$22.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.03
|
| Rate for Payer: Vantage Medical Group Senior |
$39.03
|
|
|
HC SKIN PROTECTNT REMEDY 2OZ PSTE
|
Facility
|
IP
|
$29.60
|
|
| Hospital Charge Code |
901698680
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Adventist Health Commercial |
$5.92
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Central Health Plan Commercial |
$23.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.84
|
| Rate for Payer: EPIC Health Plan Senior |
$11.84
|
| Rate for Payer: Galaxy Health WC |
$25.16
|
| Rate for Payer: Global Benefits Group Commercial |
$17.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.92
|
| Rate for Payer: Multiplan Commercial |
$22.20
|
| Rate for Payer: Networks By Design Commercial |
$19.24
|
| Rate for Payer: Prime Health Services Commercial |
$25.16
|
|
|
HC SKIN PROTECTNT REMEDY 2OZ PSTE
|
Facility
|
OP
|
$29.60
|
|
| Hospital Charge Code |
901698680
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Adventist Health Commercial |
$5.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.22
|
| Rate for Payer: Blue Shield of California Commercial |
$18.77
|
| Rate for Payer: Blue Shield of California EPN |
$11.81
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Central Health Plan Commercial |
$23.68
|
| Rate for Payer: Cigna of CA HMO |
$18.94
|
| Rate for Payer: Cigna of CA PPO |
$21.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.84
|
| Rate for Payer: EPIC Health Plan Senior |
$11.84
|
| Rate for Payer: Galaxy Health WC |
$25.16
|
| Rate for Payer: Global Benefits Group Commercial |
$17.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.72
|
| Rate for Payer: Multiplan Commercial |
$22.20
|
| Rate for Payer: Networks By Design Commercial |
$19.24
|
| Rate for Payer: Prime Health Services Commercial |
$25.16
|
| Rate for Payer: Riverside University Health System MISP |
$11.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.80
|
| Rate for Payer: United Healthcare All Other HMO |
$14.80
|
| Rate for Payer: United Healthcare HMO Rider |
$14.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.16
|
| Rate for Payer: Vantage Medical Group Senior |
$25.16
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS 1ST 100 SQ CM
|
Facility
|
IP
|
$13,125.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
900101500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,625.00 |
| Max. Negotiated Rate |
$11,812.50 |
| Rate for Payer: Adventist Health Commercial |
$2,625.00
|
| Rate for Payer: Cash Price |
$5,906.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,500.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,187.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,250.00
|
| Rate for Payer: Galaxy Health WC |
$11,156.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,875.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,812.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,334.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,743.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,625.00
|
| Rate for Payer: Multiplan Commercial |
$9,843.75
|
| Rate for Payer: Networks By Design Commercial |
$8,531.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,156.25
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS 1ST 100 SQ CM
|
Facility
|
OP
|
$13,125.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
900101500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.84 |
| Max. Negotiated Rate |
$11,812.50 |
| Rate for Payer: Adventist Health Commercial |
$2,625.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,103.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,321.25
|
| Rate for Payer: Blue Shield of California EPN |
$5,236.88
|
| Rate for Payer: Cash Price |
$5,906.25
|
| Rate for Payer: Cash Price |
$5,906.25
|
| Rate for Payer: Cash Price |
$5,906.25
|
| Rate for Payer: Central Health Plan Commercial |
$10,500.00
|
| Rate for Payer: Cigna of CA HMO |
$8,400.00
|
| Rate for Payer: Cigna of CA PPO |
$9,712.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,187.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$11,156.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,875.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,812.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$295.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,334.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,625.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$9,843.75
|
| Rate for Payer: Networks By Design Commercial |
$8,531.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Prime Health Services Commercial |
$11,156.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,875.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,875.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,562.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,562.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,562.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,562.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$6,562.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
900101501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,312.40 |
| Max. Negotiated Rate |
$5,905.80 |
| Rate for Payer: Adventist Health Commercial |
$1,312.40
|
| Rate for Payer: Cash Price |
$2,952.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,249.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,593.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,624.80
|
| Rate for Payer: Galaxy Health WC |
$5,577.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,905.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,166.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,871.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,312.40
|
| Rate for Payer: Multiplan Commercial |
$4,921.50
|
| Rate for Payer: Networks By Design Commercial |
$4,265.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,577.70
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$6,562.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
900101501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.76 |
| Max. Negotiated Rate |
$5,905.80 |
| Rate for Payer: Adventist Health Commercial |
$1,312.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$234.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,577.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,609.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,921.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,160.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,618.24
|
| Rate for Payer: Cash Price |
$2,952.90
|
| Rate for Payer: Cash Price |
$2,952.90
|
| Rate for Payer: Cash Price |
$2,952.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,249.60
|
| Rate for Payer: Cigna of CA HMO |
$4,199.68
|
| Rate for Payer: Cigna of CA PPO |
$4,855.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,577.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,577.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,577.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,593.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,624.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,624.80
|
| Rate for Payer: Galaxy Health WC |
$5,577.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,937.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,905.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,166.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,871.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,312.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,593.40
|
| Rate for Payer: Multiplan Commercial |
$4,921.50
|
| Rate for Payer: Networks By Design Commercial |
$4,265.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,577.70
|
| Rate for Payer: Riverside University Health System MISP |
$2,624.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,937.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,937.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,281.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,281.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,281.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,577.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,577.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5,577.70
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS EACH ADDL 25 SQ CM
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
900101499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,683.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,268.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.62
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: Cigna of CA HMO |
$2,289.92
|
| Rate for Payer: Cigna of CA PPO |
$2,647.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,041.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,041.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,504.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,272.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,111.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,504.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,431.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,146.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,146.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,789.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,789.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,789.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,789.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,041.30
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS EACH ADDL 25 SQ CM
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
900101499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.60 |
| Max. Negotiated Rate |
$3,220.20 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,504.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,272.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,111.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
OP
|
$4,357.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.79 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$950.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$533.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,762.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,738.44
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,485.60
|
| Rate for Payer: Cigna of CA HMO |
$2,788.48
|
| Rate for Payer: Cigna of CA PPO |
$3,224.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,049.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$3,703.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,614.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,921.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,766.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,330.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$871.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$3,267.75
|
| Rate for Payer: Networks By Design Commercial |
$2,832.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Prime Health Services Commercial |
$3,703.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,614.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,614.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,178.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,178.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,178.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,178.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
IP
|
$4,357.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$871.40 |
| Max. Negotiated Rate |
$3,921.30 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,485.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,049.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,742.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,742.80
|
| Rate for Payer: Galaxy Health WC |
$3,703.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,614.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,921.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,766.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,570.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$871.40
|
| Rate for Payer: Multiplan Commercial |
$3,267.75
|
| Rate for Payer: Networks By Design Commercial |
$2,832.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,703.45
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
IP
|
$4,357.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$871.40 |
| Max. Negotiated Rate |
$3,921.30 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,485.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,049.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,742.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,742.80
|
| Rate for Payer: Galaxy Health WC |
$3,703.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,614.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,921.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,766.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,570.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$871.40
|
| Rate for Payer: Multiplan Commercial |
$3,267.75
|
| Rate for Payer: Networks By Design Commercial |
$2,832.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,703.45
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
OP
|
$4,357.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.74 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Cash Price |
$1,960.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,485.60
|
| Rate for Payer: Cigna of CA HMO |
$2,788.48
|
| Rate for Payer: Cigna of CA PPO |
$3,224.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,049.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$3,703.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,614.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,921.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,766.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$871.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$3,267.75
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,832.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$3,703.45
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,614.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,178.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,178.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,178.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,178.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET 1ST 100 SQ CM
|
Facility
|
OP
|
$7,155.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
900101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.80 |
| Max. Negotiated Rate |
$6,439.50 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,653.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,136.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,536.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,854.84
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,724.00
|
| Rate for Payer: Cigna of CA HMO |
$4,579.20
|
| Rate for Payer: Cigna of CA PPO |
$5,294.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,008.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,439.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,543.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$336.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$5,366.25
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,293.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,293.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,577.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,577.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,577.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,577.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET 1ST 100 SQ CM
|
Facility
|
IP
|
$7,155.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
900101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,431.00 |
| Max. Negotiated Rate |
$6,439.50 |
| Rate for Payer: Adventist Health Commercial |
$1,431.00
|
| Rate for Payer: Cash Price |
$3,219.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,724.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,008.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,862.00
|
| Rate for Payer: Galaxy Health WC |
$6,081.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,293.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,439.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,543.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,221.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.25
|
| Rate for Payer: Networks By Design Commercial |
$4,650.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 100 SQ CM
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
900101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.60 |
| Max. Negotiated Rate |
$3,220.20 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,504.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,272.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,111.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 100 SQ CM
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
900101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$290.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,967.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,683.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,268.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.62
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Cash Price |
$1,610.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| Rate for Payer: Cigna of CA HMO |
$2,289.92
|
| Rate for Payer: Cigna of CA PPO |
$2,647.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,041.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,041.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,504.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,431.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,431.20
|
| Rate for Payer: Galaxy Health WC |
$3,041.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,146.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,220.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,272.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,111.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,504.60
|
| Rate for Payer: Multiplan Commercial |
$2,683.50
|
| Rate for Payer: Networks By Design Commercial |
$2,325.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,041.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,431.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,146.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,146.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,789.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,789.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,789.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,789.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,041.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,041.30
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 25 SQ CM
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
900101502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.23 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$778.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,306.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,139.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,917.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,466.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,552.11
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,112.00
|
| Rate for Payer: Cigna of CA HMO |
$2,489.60
|
| Rate for Payer: Cigna of CA PPO |
$2,878.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,306.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,306.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,306.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,723.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,556.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,556.00
|
| Rate for Payer: Galaxy Health WC |
$3,306.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,334.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,501.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,470.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,295.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,723.00
|
| Rate for Payer: Multiplan Commercial |
$2,917.50
|
| Rate for Payer: Networks By Design Commercial |
$2,528.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,306.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,556.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,334.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,334.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,945.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,945.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,945.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,945.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,306.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,306.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,306.50
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 25 SQ CM
|
Facility
|
IP
|
$3,890.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
900101502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$778.00 |
| Max. Negotiated Rate |
$3,501.00 |
| Rate for Payer: Adventist Health Commercial |
$778.00
|
| Rate for Payer: Cash Price |
$1,750.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,112.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,723.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,556.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,556.00
|
| Rate for Payer: Galaxy Health WC |
$3,306.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,334.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,501.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,470.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,295.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$778.00
|
| Rate for Payer: Multiplan Commercial |
$2,917.50
|
| Rate for Payer: Networks By Design Commercial |
$2,528.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,306.50
|
|
|
HC SKIN SUBSTITUTE PRIMATRIX 3X3
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$405.32 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.44
|
| Rate for Payer: Blue Shield of California Commercial |
$168.01
|
| Rate for Payer: Blue Shield of California EPN |
$105.73
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC SKIN SUBSTITUTE PRIMATRIX 3X3
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC SKULL COMPLETE
|
Facility
|
OP
|
$1,568.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.18 |
| Max. Negotiated Rate |
$1,411.20 |
| Rate for Payer: Adventist Health Commercial |
$313.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$195.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$186.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.90
|
| Rate for Payer: Blue Shield of California Commercial |
$987.84
|
| Rate for Payer: Blue Shield of California EPN |
$622.50
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,254.40
|
| Rate for Payer: Cigna of CA HMO |
$1,003.52
|
| Rate for Payer: Cigna of CA PPO |
$1,160.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,097.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,332.80
|
| Rate for Payer: Global Benefits Group Commercial |
$940.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,411.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$995.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,176.00
|
| Rate for Payer: Networks By Design Commercial |
$1,019.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,332.80
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$940.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$940.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC SKULL COMPLETE
|
Facility
|
IP
|
$1,568.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.60 |
| Max. Negotiated Rate |
$1,411.20 |
| Rate for Payer: Adventist Health Commercial |
$313.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,254.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,097.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.20
|
| Rate for Payer: EPIC Health Plan Senior |
$627.20
|
| Rate for Payer: Galaxy Health WC |
$1,332.80
|
| Rate for Payer: Global Benefits Group Commercial |
$940.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,411.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$995.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$925.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.60
|
| Rate for Payer: Multiplan Commercial |
$1,176.00
|
| Rate for Payer: Networks By Design Commercial |
$1,019.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,332.80
|
|
