|
HC SKIN AFFIX TOPICAL ADHESIVE
|
Facility
|
IP
|
$129.20
|
|
| Hospital Charge Code |
901607899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$116.28 |
| Rate for Payer: Cash Price |
$58.14
|
| Rate for Payer: Central Health Plan Commercial |
$103.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.68
|
| Rate for Payer: Galaxy Health WC |
$109.82
|
| Rate for Payer: Global Benefits Group Commercial |
$77.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.84
|
| Rate for Payer: Multiplan Commercial |
$96.90
|
| Rate for Payer: Networks By Design Commercial |
$83.98
|
| Rate for Payer: Prime Health Services Commercial |
$109.82
|
|
|
HC SKIN BARRIER 3ML FOAM STNGFREE
|
Facility
|
OP
|
$10.66
|
|
|
Service Code
|
CPT A4369
|
| Hospital Charge Code |
901607709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Distinction Transplant |
$6.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6.71
|
| Rate for Payer: Blue Shield of California EPN |
$5.21
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Central Health Plan Commercial |
$8.53
|
| Rate for Payer: Cigna of CA HMO |
$6.82
|
| Rate for Payer: Cigna of CA PPO |
$7.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: Dignity Health Media |
$9.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.26
|
| Rate for Payer: Galaxy Health WC |
$9.06
|
| Rate for Payer: Global Benefits Group Commercial |
$6.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.13
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$9.06
|
| Rate for Payer: Riverside University Health System MISP |
$4.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.06
|
| Rate for Payer: Vantage Medical Group Senior |
$9.06
|
|
|
HC SKIN BARRIER 3ML FOAM STNGFREE
|
Facility
|
IP
|
$10.66
|
|
|
Service Code
|
CPT A4369
|
| Hospital Charge Code |
901607709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Central Health Plan Commercial |
$8.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.26
|
| Rate for Payer: Galaxy Health WC |
$9.06
|
| Rate for Payer: Global Benefits Group Commercial |
$6.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.13
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$9.06
|
|
|
HC SKIN BARRIER 3ML SUREPREP WAND
|
Facility
|
OP
|
$12.96
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.66
|
| Rate for Payer: Blue Distinction Transplant |
$7.78
|
| Rate for Payer: Blue Shield of California Commercial |
$8.15
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Central Health Plan Commercial |
$10.37
|
| Rate for Payer: Cigna of CA HMO |
$8.29
|
| Rate for Payer: Cigna of CA PPO |
$9.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.02
|
| Rate for Payer: Dignity Health Media |
$11.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.66
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$9.72
|
| Rate for Payer: Networks By Design Commercial |
$8.42
|
| Rate for Payer: Prime Health Services Commercial |
$11.02
|
| Rate for Payer: Riverside University Health System MISP |
$5.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO |
$6.48
|
| Rate for Payer: United Healthcare HMO Rider |
$6.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.02
|
| Rate for Payer: Vantage Medical Group Senior |
$11.02
|
|
|
HC SKIN BARRIER 3ML SUREPREP WAND
|
Facility
|
IP
|
$12.96
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Central Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$9.72
|
| Rate for Payer: Networks By Design Commercial |
$8.42
|
| Rate for Payer: Prime Health Services Commercial |
$11.02
|
|
|
HC SKIN CLOSURE 1/2 X 4"
|
Facility
|
OP
|
$29.52
|
|
| Hospital Charge Code |
901605433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.44
|
| Rate for Payer: Blue Distinction Transplant |
$17.71
|
| Rate for Payer: Blue Shield of California Commercial |
$18.57
|
| Rate for Payer: Blue Shield of California EPN |
$14.44
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Central Health Plan Commercial |
$23.62
|
| Rate for Payer: Cigna of CA HMO |
$18.89
|
| Rate for Payer: Cigna of CA PPO |
$21.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.09
|
| Rate for Payer: Dignity Health Media |
$25.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.81
|
| Rate for Payer: Galaxy Health WC |
$25.09
|
| Rate for Payer: Global Benefits Group Commercial |
$17.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.57
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$22.14
|
| Rate for Payer: Networks By Design Commercial |
$19.19
|
| Rate for Payer: Prime Health Services Commercial |
$25.09
|
| Rate for Payer: Riverside University Health System MISP |
$11.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.76
|
| Rate for Payer: United Healthcare All Other HMO |
$14.76
|
| Rate for Payer: United Healthcare HMO Rider |
$14.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.09
|
| Rate for Payer: Vantage Medical Group Senior |
$25.09
|
|
|
HC SKIN CLOSURE 1/2 X 4"
|
Facility
|
IP
|
$29.52
|
|
| Hospital Charge Code |
901605433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Central Health Plan Commercial |
$23.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.81
|
| Rate for Payer: Galaxy Health WC |
$25.09
|
| Rate for Payer: Global Benefits Group Commercial |
$17.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$22.14
|
| Rate for Payer: Networks By Design Commercial |
$19.19
|
| Rate for Payer: Prime Health Services Commercial |
$25.09
|
|
|
HC SKIN CLOSURE 1/4 X 3"
|
Facility
|
OP
|
$29.44
|
|
| Hospital Charge Code |
901605431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$26.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.39
|
| Rate for Payer: Blue Distinction Transplant |
$17.66
|
| Rate for Payer: Blue Shield of California Commercial |
$18.52
|
| Rate for Payer: Blue Shield of California EPN |
$14.40
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Central Health Plan Commercial |
$23.55
|
| Rate for Payer: Cigna of CA HMO |
$18.84
|
| Rate for Payer: Cigna of CA PPO |
$21.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.02
|
| Rate for Payer: Dignity Health Media |
$25.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.78
|
| Rate for Payer: Galaxy Health WC |
$25.02
|
| Rate for Payer: Global Benefits Group Commercial |
$17.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.89
|
| Rate for Payer: Multiplan Commercial |
$22.08
|
| Rate for Payer: Networks By Design Commercial |
$19.14
|
| Rate for Payer: Prime Health Services Commercial |
$25.02
|
| Rate for Payer: Riverside University Health System MISP |
$11.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.72
|
| Rate for Payer: United Healthcare All Other HMO |
$14.72
|
| Rate for Payer: United Healthcare HMO Rider |
$14.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.02
|
| Rate for Payer: Vantage Medical Group Senior |
$25.02
|
|
|
HC SKIN CLOSURE 1/4 X 3"
|
Facility
|
IP
|
$29.44
|
|
| Hospital Charge Code |
901605431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$26.50 |
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Central Health Plan Commercial |
$23.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.78
|
| Rate for Payer: Galaxy Health WC |
$25.02
|
| Rate for Payer: Global Benefits Group Commercial |
$17.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.89
|
| Rate for Payer: Multiplan Commercial |
$22.08
|
| Rate for Payer: Networks By Design Commercial |
$19.14
|
| Rate for Payer: Prime Health Services Commercial |
$25.02
|
|
|
HC SKIN CLOSURE 1/4 X 4"
|
Facility
|
OP
|
$29.77
|
|
| Hospital Charge Code |
901605432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.59
|
| Rate for Payer: Blue Distinction Transplant |
$17.86
|
| Rate for Payer: Blue Shield of California Commercial |
$18.73
|
| Rate for Payer: Blue Shield of California EPN |
$14.56
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Central Health Plan Commercial |
$23.82
|
| Rate for Payer: Cigna of CA HMO |
$19.05
|
| Rate for Payer: Cigna of CA PPO |
$22.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Media |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.79
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.95
|
| Rate for Payer: Multiplan Commercial |
$22.33
|
| Rate for Payer: Networks By Design Commercial |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Riverside University Health System MISP |
$11.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
|
|
HC SKIN CLOSURE 1/4 X 4"
|
Facility
|
IP
|
$29.77
|
|
| Hospital Charge Code |
901605432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Central Health Plan Commercial |
$23.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.95
|
| Rate for Payer: Multiplan Commercial |
$22.33
|
| Rate for Payer: Networks By Design Commercial |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
|
|
HC SKIN CLOSURE 1/8 X 3"
|
Facility
|
IP
|
$9.10
|
|
| Hospital Charge Code |
901605430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
|
|
HC SKIN CLOSURE 1/8 X 3"
|
Facility
|
OP
|
$9.10
|
|
| Hospital Charge Code |
901605430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.38
|
| Rate for Payer: Blue Distinction Transplant |
$5.46
|
| Rate for Payer: Blue Shield of California Commercial |
$5.72
|
| Rate for Payer: Blue Shield of California EPN |
$4.45
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Media |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Riverside University Health System MISP |
$3.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Other HMO |
$4.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
|
|
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: 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 |
$68.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.77
|
| Rate for Payer: Blue Distinction Transplant |
$74.92
|
| Rate for Payer: Blue Shield of California Commercial |
$78.54
|
| Rate for Payer: Blue Shield of California EPN |
$61.06
|
| Rate for Payer: Cash Price |
$56.19
|
| 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 Media |
$106.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$93.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.70
|
| 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: 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
|
| 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 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: Cash Price |
$56.19
|
| Rate for Payer: Central Health Plan Commercial |
$99.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
OP
|
$21.40
|
|
| Hospital Charge Code |
901604398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$19.26 |
| 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 |
$11.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.64
|
| Rate for Payer: Blue Distinction Transplant |
$12.84
|
| Rate for Payer: Blue Shield of California Commercial |
$13.46
|
| Rate for Payer: Blue Shield of California EPN |
$10.46
|
| Rate for Payer: Cash Price |
$9.63
|
| 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 Media |
$18.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$16.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.49
|
| 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: 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
|
| 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 Medi-Cal |
$18.19
|
| Rate for Payer: Vantage Medical Group Senior |
$18.19
|
|
|
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: Cash Price |
$9.63
|
| Rate for Payer: Central Health Plan Commercial |
$17.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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 |
$18.22 |
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Central Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 |
$18.22
|
| 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: 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 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 |
$18.22 |
| 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 |
$11.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.96
|
| Rate for Payer: Blue Distinction Transplant |
$12.15
|
| Rate for Payer: Blue Shield of California Commercial |
$12.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.90
|
| 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 Media |
$17.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$18.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.09
|
| 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: 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
|
| 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 Medi-Cal |
$17.21
|
| Rate for Payer: Vantage Medical Group Senior |
$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: 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 |
$25.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.13
|
| Rate for Payer: Blue Distinction Transplant |
$27.55
|
| Rate for Payer: Blue Shield of California Commercial |
$28.88
|
| Rate for Payer: Blue Shield of California EPN |
$22.45
|
| 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 Media |
$39.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$34.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.07
|
| 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: 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
|
| 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 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: Cash Price |
$20.66
|
| Rate for Payer: Central Health Plan Commercial |
$36.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
IP
|
$29.60
|
|
| Hospital Charge Code |
901698680
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Central Health Plan Commercial |
$23.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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: 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 |
$16.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.49
|
| Rate for Payer: Blue Distinction Transplant |
$17.76
|
| Rate for Payer: Blue Shield of California Commercial |
$18.62
|
| Rate for Payer: Blue Shield of California EPN |
$14.47
|
| 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 Media |
$25.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$22.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.36
|
| 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: 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
|
| 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 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
|
$9,924.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
900101500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,984.80 |
| Max. Negotiated Rate |
$8,931.60 |
| Rate for Payer: Cash Price |
$4,465.80
|
| Rate for Payer: Central Health Plan Commercial |
$7,939.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,969.60
|
| Rate for Payer: Galaxy Health WC |
$8,435.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,954.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,931.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,619.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,781.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,984.80
|
| Rate for Payer: Multiplan Commercial |
$7,443.00
|
| Rate for Payer: Networks By Design Commercial |
$6,450.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,435.40
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS 1ST 100 SQ CM
|
Facility
|
OP
|
$9,924.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
900101500
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.74 |
| Max. Negotiated Rate |
$8,931.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,482.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,723.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,930.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,482.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,954.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,242.20
|
| Rate for Payer: Blue Shield of California EPN |
$4,852.84
|
| Rate for Payer: Caremore Medicare Advantage |
$4,482.50
|
| Rate for Payer: Cash Price |
$4,465.80
|
| Rate for Payer: Cash Price |
$4,465.80
|
| Rate for Payer: Central Health Plan Commercial |
$7,939.20
|
| Rate for Payer: Cigna of CA HMO |
$6,351.36
|
| Rate for Payer: Cigna of CA PPO |
$7,343.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,723.75
|
| Rate for Payer: Dignity Health Media |
$4,482.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,051.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,482.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,482.50
|
| Rate for Payer: Galaxy Health WC |
$8,435.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,954.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,931.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,443.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,351.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,396.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,482.50
|
| Rate for Payer: InnovAge PACE Commercial |
$6,723.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,619.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,482.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,984.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,006.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,006.55
|
| Rate for Payer: Multiplan Commercial |
$7,443.00
|
| Rate for Payer: Networks By Design Commercial |
$6,450.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,435.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,751.45
|
| Rate for Payer: Riverside University Health System MISP |
$4,930.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,954.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,954.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,962.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,962.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,962.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,962.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,723.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,482.50
|
|
