|
HC SKIN CLOSURE 1/8 X 3"
|
Facility
|
IP
|
$4.43
|
|
| Hospital Charge Code |
901605430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.99 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Central Health Plan Commercial |
$3.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Multiplan Commercial |
$3.32
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
|
|
HC SKIN CLOSURE 1/8 X 3"
|
Facility
|
OP
|
$4.43
|
|
| Hospital Charge Code |
901605430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.99 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2.71
|
| Rate for Payer: Blue Shield of California EPN |
$1.77
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Central Health Plan Commercial |
$3.54
|
| Rate for Payer: Cigna of CA HMO |
$2.84
|
| Rate for Payer: Cigna of CA PPO |
$3.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.99
|
| Rate for Payer: InnovAge PACE Commercial |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$3.32
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
| Rate for Payer: Riverside University Health System MISP |
$1.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.77
|
| Rate for Payer: Vantage Medical Group Senior |
$3.77
|
|
|
HC SKIN CLOSURE 1 X 4"
|
Facility
|
OP
|
$124.87
|
|
| Hospital Charge Code |
901605434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$112.38 |
| Rate for Payer: Adventist Health Commercial |
$24.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.34
|
| Rate for Payer: Blue Shield of California Commercial |
$76.30
|
| Rate for Payer: Blue Shield of California EPN |
$49.82
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Central Health Plan Commercial |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$79.92
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.95
|
| Rate for Payer: EPIC Health Plan Senior |
$49.95
|
| Rate for Payer: Galaxy Health WC |
$106.14
|
| Rate for Payer: Global Benefits Group Commercial |
$74.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.38
|
| Rate for Payer: InnovAge PACE Commercial |
$62.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.41
|
| Rate for Payer: Multiplan Commercial |
$93.65
|
| Rate for Payer: Networks By Design Commercial |
$81.17
|
| Rate for Payer: Prime Health Services Commercial |
$106.14
|
| Rate for Payer: Riverside University Health System MISP |
$49.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.44
|
| Rate for Payer: United Healthcare All Other HMO |
$62.44
|
| Rate for Payer: United Healthcare HMO Rider |
$62.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.14
|
| Rate for Payer: Vantage Medical Group Senior |
$106.14
|
|
|
HC SKIN CLOSURE 1 X 4"
|
Facility
|
IP
|
$124.87
|
|
| Hospital Charge Code |
901605434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$112.38 |
| Rate for Payer: Adventist Health Commercial |
$24.97
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Central Health Plan Commercial |
$99.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.95
|
| Rate for Payer: EPIC Health Plan Senior |
$49.95
|
| Rate for Payer: Galaxy Health WC |
$106.14
|
| Rate for Payer: Global Benefits Group Commercial |
$74.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.97
|
| Rate for Payer: Multiplan Commercial |
$93.65
|
| Rate for Payer: Networks By Design Commercial |
$81.17
|
| Rate for Payer: Prime Health Services Commercial |
$106.14
|
|
|
HC SKIN CLOSURES 1" X 5"
|
Facility
|
IP
|
$21.40
|
|
| Hospital Charge Code |
901604398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$19.26 |
| Rate for Payer: Adventist Health Commercial |
$4.28
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Central Health Plan Commercial |
$17.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.56
|
| Rate for Payer: EPIC Health Plan Senior |
$8.56
|
| Rate for Payer: Galaxy Health WC |
$18.19
|
| Rate for Payer: Global Benefits Group Commercial |
$12.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.28
|
| Rate for Payer: Multiplan Commercial |
$16.05
|
| Rate for Payer: Networks By Design Commercial |
$13.91
|
| Rate for Payer: Prime Health Services Commercial |
$18.19
|
|
|
HC SKIN CLOSURES 1" X 5"
|
Facility
|
OP
|
$21.40
|
|
| Hospital Charge Code |
901604398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$19.26 |
| Rate for Payer: Adventist Health Commercial |
$4.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.57
|
| Rate for Payer: Blue Shield of California Commercial |
$13.08
|
| Rate for Payer: Blue Shield of California EPN |
$8.54
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Central Health Plan Commercial |
$17.12
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$15.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.56
|
| Rate for Payer: EPIC Health Plan Senior |
$8.56
|
| Rate for Payer: Galaxy Health WC |
$18.19
|
| Rate for Payer: Global Benefits Group Commercial |
$12.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.26
|
| Rate for Payer: InnovAge PACE Commercial |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.98
|
| Rate for Payer: Multiplan Commercial |
$16.05
|
| Rate for Payer: Networks By Design Commercial |
$13.91
|
| Rate for Payer: Prime Health Services Commercial |
$18.19
|
| Rate for Payer: Riverside University Health System MISP |
$8.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.70
|
| Rate for Payer: United Healthcare All Other HMO |
$10.70
|
| Rate for Payer: United Healthcare HMO Rider |
$10.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.19
|
| Rate for Payer: Vantage Medical Group Senior |
$18.19
|
|
|
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 |
$11.89
|
| Rate for Payer: Blue Shield of California Commercial |
$12.37
|
| Rate for Payer: Blue Shield of California EPN |
$8.08
|
| Rate for Payer: Cash Price |
$11.14
|
| 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: 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: InnovAge PACE Commercial |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.18
|
| Rate for Payer: Molina Healthcare of CA 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 PRO PASTE PHYTOPLEX 2 OZ
|
Facility
|
IP
|
$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: Cash Price |
$11.14
|
| Rate for Payer: Central Health Plan Commercial |
$16.20
|
| 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 Permanente of CA Commercial/Self Funded |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| 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
|
|
|
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 |
$26.97
|
| Rate for Payer: Blue Shield of California Commercial |
$28.06
|
| Rate for Payer: Blue Shield of California EPN |
$18.32
|
| Rate for Payer: Cash Price |
$25.26
|
| 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: 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: InnovAge PACE Commercial |
$22.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.14
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$25.26
|
| Rate for Payer: Central Health Plan Commercial |
$36.74
|
| 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 Permanente of CA Commercial/Self Funded |
$30.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.42
|
| 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 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 |
$17.38
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$11.81
|
| Rate for Payer: Cash Price |
$16.28
|
| 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: 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: InnovAge PACE Commercial |
$14.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.72
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$16.28
|
| Rate for Payer: Central Health Plan Commercial |
$23.68
|
| 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 Permanente of CA Commercial/Self Funded |
$19.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.32
|
| 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 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 |
$4,651.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,977.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,116.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,651.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,019.38
|
| Rate for Payer: Blue Shield of California EPN |
$5,236.88
|
| Rate for Payer: Cash Price |
$7,218.75
|
| Rate for Payer: Cash Price |
$7,218.75
|
| Rate for Payer: Cash Price |
$7,218.75
|
| 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 |
$6,977.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,116.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,651.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,279.70
|
| Rate for Payer: EPIC Health Plan Senior |
$4,651.63
|
| 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 |
$7,628.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$295.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,651.63
|
| Rate for Payer: InnovAge PACE Commercial |
$6,977.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,754.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,651.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,625.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,233.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,233.18
|
| 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 |
$4,651.63
|
| Rate for Payer: Prime Health Services Commercial |
$11,156.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,930.73
|
| Rate for Payer: Riverside University Health System MISP |
$5,116.79
|
| 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 |
$4,651.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,977.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,116.79
|
| Rate for Payer: Vantage Medical Group Senior |
$4,651.63
|
|
|
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 |
$7,218.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,500.00
|
| 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 Permanente of CA Commercial/Self Funded |
$8,754.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,000.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,124.38
|
| 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 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 |
$2,901.00
|
| 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 |
$3,177.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,853.86
|
| Rate for Payer: Blue Shield of California Commercial |
$4,009.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,618.24
|
| Rate for Payer: Cash Price |
$3,609.10
|
| Rate for Payer: Cash Price |
$3,609.10
|
| Rate for Payer: Cash Price |
$3,609.10
|
| 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: 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: InnovAge PACE Commercial |
$3,281.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,376.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,061.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,312.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,593.40
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$3,609.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,249.60
|
| 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 Permanente of CA Commercial/Self Funded |
$4,376.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,500.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,061.88
|
| 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 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 |
$1,967.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,862.40
|
| 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 Permanente of CA Commercial/Self Funded |
$2,386.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,363.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.78
|
| 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 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 |
$3,220.20 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$1,732.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,101.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,186.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.62
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Cash Price |
$1,967.90
|
| 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: 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: InnovAge PACE Commercial |
$1,789.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,386.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,504.60
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$2,396.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,485.60
|
| 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 Permanente of CA Commercial/Self Funded |
$2,906.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,660.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,696.98
|
| 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 |
$2,396.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,485.60
|
| 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 Permanente of CA Commercial/Self Funded |
$2,906.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,660.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,696.98
|
| 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
|
761
|
| Min. Negotiated Rate |
$142.79 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$871.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,324.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,662.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,738.44
|
| Rate for Payer: Cash Price |
$2,396.35
|
| Rate for Payer: Cash Price |
$2,396.35
|
| Rate for Payer: Cash Price |
$2,396.35
|
| 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 |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| 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 |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,906.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$871.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| 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 |
$2,324.22
|
| Rate for Payer: Prime Health Services Commercial |
$3,703.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| 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 |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
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 |
$6,333.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$2,396.35
|
| Rate for Payer: Cash Price |
$2,396.35
|
| Rate for Payer: Cash Price |
$2,396.35
|
| Rate for Payer: Cash Price |
$2,396.35
|
| 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 |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| 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 |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,906.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$871.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| 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 |
$2,324.22
|
| 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 |
$2,463.67
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| 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 |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
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 |
$2,324.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,371.70
|
| Rate for Payer: Blue Shield of California EPN |
$2,854.84
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Cash Price |
$3,935.25
|
| Rate for Payer: Cash Price |
$3,935.25
|
| 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 |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| 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 |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$304.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: InnovAge PACE Commercial |
$3,486.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,431.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,114.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| 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 |
$2,324.22
|
| Rate for Payer: Prime Health Services Commercial |
$6,081.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,463.67
|
| Rate for Payer: Riverside University Health System MISP |
$2,556.64
|
| 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 |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
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 |
$3,935.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,724.00
|
| 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 Permanente of CA Commercial/Self Funded |
$4,772.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,726.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,428.94
|
| 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
|
OP
|
$3,578.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
900101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$3,220.20 |
| Rate for Payer: Adventist Health Commercial |
$715.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$1,732.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,101.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,186.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.62
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Cash Price |
$1,967.90
|
| Rate for Payer: Cash Price |
$1,967.90
|
| 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: 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: InnovAge PACE Commercial |
$1,789.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,386.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,214.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,504.60
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
