|
HC SKIN SUB GRAFT TRUNK ARMS LEGS EACH ADDL 100 SQ CM
|
Facility
|
OP
|
$4,962.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
900101501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.62 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,217.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,729.10
|
| 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 |
$2,977.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,121.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,426.42
|
| Rate for Payer: Cash Price |
$2,232.90
|
| Rate for Payer: Cash Price |
$2,232.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,969.60
|
| Rate for Payer: Cigna of CA HMO |
$3,175.68
|
| Rate for Payer: Cigna of CA PPO |
$3,671.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,217.70
|
| Rate for Payer: Dignity Health Media |
$4,217.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,217.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,984.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,984.80
|
| Rate for Payer: Galaxy Health WC |
$4,217.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,977.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,465.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,721.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,736.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,309.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.40
|
| Rate for Payer: Multiplan Commercial |
$3,721.50
|
| Rate for Payer: Networks By Design Commercial |
$3,225.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,217.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,984.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,977.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,977.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,481.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,481.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,481.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,481.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,217.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,217.70
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS EACH ADDL 100 SQ CM
|
Facility
|
IP
|
$4,962.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
900101501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$992.40 |
| Max. Negotiated Rate |
$4,465.80 |
| Rate for Payer: Cash Price |
$2,232.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,969.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,984.80
|
| Rate for Payer: Galaxy Health WC |
$4,217.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,977.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,465.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,309.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,890.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.40
|
| Rate for Payer: Multiplan Commercial |
$3,721.50
|
| Rate for Payer: Networks By Design Commercial |
$3,225.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,217.70
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS EACH ADDL 25 SQ CM
|
Facility
|
IP
|
$2,705.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
900101499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.00 |
| Max. Negotiated Rate |
$2,434.50 |
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,082.00
|
| Rate for Payer: Galaxy Health WC |
$2,299.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,623.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,434.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,804.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,030.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.75
|
| Rate for Payer: Networks By Design Commercial |
$1,758.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,299.25
|
|
|
HC SKIN SUB GRAFT TRUNK ARMS LEGS EACH ADDL 25 SQ CM
|
Facility
|
OP
|
$2,705.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
900101499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.19 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,299.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,487.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,487.75
|
| 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 |
$1,623.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,701.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,322.74
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,164.00
|
| Rate for Payer: Cigna of CA HMO |
$1,731.20
|
| Rate for Payer: Cigna of CA PPO |
$2,001.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,299.25
|
| Rate for Payer: Dignity Health Media |
$2,299.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,299.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,082.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,082.00
|
| Rate for Payer: Galaxy Health WC |
$2,299.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,623.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,434.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,028.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$946.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,804.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.75
|
| Rate for Payer: Networks By Design Commercial |
$1,758.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,299.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,082.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,623.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,623.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,352.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,352.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,352.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,299.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,299.25
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
IP
|
$3,295.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$659.00 |
| Max. Negotiated Rate |
$2,965.50 |
| Rate for Payer: Cash Price |
$1,482.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,318.00
|
| Rate for Payer: Galaxy Health WC |
$2,800.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,977.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,965.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,197.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,255.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$659.00
|
| Rate for Payer: Multiplan Commercial |
$2,471.25
|
| Rate for Payer: Networks By Design Commercial |
$2,141.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,800.75
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
OP
|
$3,295.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.87 |
| Max. Negotiated Rate |
$6,248.00 |
| 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 |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,977.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$1,482.75
|
| Rate for Payer: Cash Price |
$1,482.75
|
| Rate for Payer: Cash Price |
$1,482.75
|
| Rate for Payer: Cash Price |
$1,482.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,636.00
|
| Rate for Payer: Cigna of CA PPO |
$2,438.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$2,800.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,977.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,965.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,471.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,197.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$659.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$2,471.25
|
| Rate for Payer: Networks By Design Commercial |
$2,141.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,800.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,977.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,647.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,647.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,647.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,647.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
OP
|
$3,295.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.87 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| 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 |
$1,977.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,072.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,611.26
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$1,482.75
|
| Rate for Payer: Cash Price |
$1,482.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,636.00
|
| Rate for Payer: Cigna of CA HMO |
$2,108.80
|
| Rate for Payer: Cigna of CA PPO |
$2,438.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$2,800.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,977.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,965.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,471.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,759.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,197.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$659.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$2,471.25
|
| Rate for Payer: Networks By Design Commercial |
$2,141.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,800.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,977.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,977.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,647.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,647.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,647.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,647.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
IP
|
$3,295.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$659.00 |
| Max. Negotiated Rate |
$2,965.50 |
| Rate for Payer: Cash Price |
$1,482.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,636.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,318.00
|
| Rate for Payer: Galaxy Health WC |
$2,800.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,977.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,965.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,197.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,255.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$659.00
|
| Rate for Payer: Multiplan Commercial |
$2,471.25
|
| Rate for Payer: Networks By Design Commercial |
$2,141.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,800.75
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET 1ST 100 SQ CM
|
Facility
|
IP
|
$5,410.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
900101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,082.00 |
| Max. Negotiated Rate |
$4,869.00 |
| Rate for Payer: Cash Price |
$2,434.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,328.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,164.00
|
| Rate for Payer: Galaxy Health WC |
$4,598.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,869.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,608.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,061.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.00
|
| Rate for Payer: Multiplan Commercial |
$4,057.50
|
| Rate for Payer: Networks By Design Commercial |
$3,516.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,598.50
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET 1ST 100 SQ CM
|
Facility
|
OP
|
$5,410.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
900101503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.58 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| 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 |
$3,246.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,402.89
|
| Rate for Payer: Blue Shield of California EPN |
$2,645.49
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$2,434.50
|
| Rate for Payer: Cash Price |
$2,434.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,328.00
|
| Rate for Payer: Cigna of CA HMO |
$3,462.40
|
| Rate for Payer: Cigna of CA PPO |
$4,003.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$4,598.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,869.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,057.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,759.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,608.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$4,057.50
|
| Rate for Payer: Networks By Design Commercial |
$3,516.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,598.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,705.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,705.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,705.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,705.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 100 SQ CM
|
Facility
|
IP
|
$2,705.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
900101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.00 |
| Max. Negotiated Rate |
$2,434.50 |
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,082.00
|
| Rate for Payer: Galaxy Health WC |
$2,299.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,623.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,434.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,804.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,030.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.75
|
| Rate for Payer: Networks By Design Commercial |
$1,758.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,299.25
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 100 SQ CM
|
Facility
|
OP
|
$2,705.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
900101504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.30 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,299.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,487.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,487.75
|
| 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 |
$1,623.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,701.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,322.74
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,164.00
|
| Rate for Payer: Cigna of CA HMO |
$1,731.20
|
| Rate for Payer: Cigna of CA PPO |
$2,001.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,299.25
|
| Rate for Payer: Dignity Health Media |
$2,299.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,299.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,082.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,082.00
|
| Rate for Payer: Galaxy Health WC |
$2,299.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,623.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,434.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,028.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$946.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,804.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.75
|
| Rate for Payer: Networks By Design Commercial |
$1,758.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,299.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,082.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,623.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,623.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,352.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,352.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,352.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,299.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,299.25
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 25 SQ CM
|
Facility
|
OP
|
$2,942.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
900101502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.68 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,500.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,618.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,618.10
|
| 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 |
$1,765.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,850.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,438.64
|
| Rate for Payer: Cash Price |
$1,323.90
|
| Rate for Payer: Cash Price |
$1,323.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,353.60
|
| Rate for Payer: Cigna of CA HMO |
$1,882.88
|
| Rate for Payer: Cigna of CA PPO |
$2,177.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,500.70
|
| Rate for Payer: Dignity Health Media |
$2,500.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,500.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,176.80
|
| Rate for Payer: Galaxy Health WC |
$2,500.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,765.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,647.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,206.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,029.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,962.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.40
|
| Rate for Payer: Multiplan Commercial |
$2,206.50
|
| Rate for Payer: Networks By Design Commercial |
$1,912.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,500.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,176.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,765.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,765.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,471.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,471.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,471.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,471.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,500.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,500.70
|
|
|
HC SKIN SUB GRFT HEAD HANDS DIGITS FEET ADDL 25 SQ CM
|
Facility
|
IP
|
$2,942.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
900101502
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$588.40 |
| Max. Negotiated Rate |
$2,647.80 |
| Rate for Payer: Cash Price |
$1,323.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.80
|
| Rate for Payer: Galaxy Health WC |
$2,500.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,765.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,647.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,962.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,120.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.40
|
| Rate for Payer: Multiplan Commercial |
$2,206.50
|
| Rate for Payer: Networks By Design Commercial |
$1,912.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,500.70
|
|
|
HC SKIN SUBSTITUTE PRIMATRIX 3X3
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Blue Shield of California Commercial |
$198.75
|
| Rate for Payer: Blue Shield of California EPN |
$141.51
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.06
|
| Rate for Payer: United Healthcare All Other HMO |
$97.73
|
| Rate for Payer: United Healthcare HMO Rider |
$95.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.45
|
|
|
HC SKIN SUBSTITUTE PRIMATRIX 3X3
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$242.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.84
|
| Rate for Payer: Blue Distinction Transplant |
$159.00
|
| Rate for Payer: Blue Shield of California Commercial |
$166.68
|
| Rate for Payer: Blue Shield of California EPN |
$129.58
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Media |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC SKULL COMPLETE
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$1,270.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$186.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$228.03
|
| Rate for Payer: Blue Distinction Transplant |
$847.20
|
| Rate for Payer: Blue Shield of California Commercial |
$872.62
|
| Rate for Payer: Blue Shield of California EPN |
$686.23
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,129.60
|
| Rate for Payer: Cigna of CA HMO |
$903.68
|
| Rate for Payer: Cigna of CA PPO |
$1,044.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,200.20
|
| Rate for Payer: Global Benefits Group Commercial |
$847.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,270.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,059.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,059.00
|
| Rate for Payer: Networks By Design Commercial |
$917.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,200.20
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$847.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$847.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SKULL COMPLETE
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$282.40 |
| Max. Negotiated Rate |
$1,270.80 |
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.80
|
| Rate for Payer: Galaxy Health WC |
$1,200.20
|
| Rate for Payer: Global Benefits Group Commercial |
$847.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,270.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$941.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$537.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.40
|
| Rate for Payer: Multiplan Commercial |
$1,059.00
|
| Rate for Payer: Networks By Design Commercial |
$917.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,200.20
|
|
|
HC SKULL LIMITED
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$951.30 |
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
|
|
HC SKULL LIMITED
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$951.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.83
|
| Rate for Payer: Blue Distinction Transplant |
$634.20
|
| Rate for Payer: Blue Shield of California Commercial |
$653.23
|
| Rate for Payer: Blue Shield of California EPN |
$513.70
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: Cigna of CA HMO |
$676.48
|
| Rate for Payer: Cigna of CA PPO |
$782.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$792.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$634.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SLEEE, KNEE OPEN PATELLA X-LG
|
Facility
|
IP
|
$53.79
|
|
| Hospital Charge Code |
901603169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$48.41 |
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Central Health Plan Commercial |
$43.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.52
|
| Rate for Payer: Galaxy Health WC |
$45.72
|
| Rate for Payer: Global Benefits Group Commercial |
$32.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.76
|
| Rate for Payer: Multiplan Commercial |
$40.34
|
| Rate for Payer: Networks By Design Commercial |
$34.96
|
| Rate for Payer: Prime Health Services Commercial |
$45.72
|
|
|
HC SLEEE, KNEE OPEN PATELLA X-LG
|
Facility
|
OP
|
$53.79
|
|
| Hospital Charge Code |
901603169
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$48.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.78
|
| Rate for Payer: Blue Distinction Transplant |
$32.27
|
| Rate for Payer: Blue Shield of California Commercial |
$33.83
|
| Rate for Payer: Blue Shield of California EPN |
$26.30
|
| Rate for Payer: Cash Price |
$24.21
|
| Rate for Payer: Central Health Plan Commercial |
$43.03
|
| Rate for Payer: Cigna of CA HMO |
$34.43
|
| Rate for Payer: Cigna of CA PPO |
$39.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.72
|
| Rate for Payer: Dignity Health Media |
$45.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.52
|
| Rate for Payer: Galaxy Health WC |
$45.72
|
| Rate for Payer: Global Benefits Group Commercial |
$32.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$40.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.76
|
| Rate for Payer: Multiplan Commercial |
$40.34
|
| Rate for Payer: Networks By Design Commercial |
$34.96
|
| Rate for Payer: Prime Health Services Commercial |
$45.72
|
| Rate for Payer: Riverside University Health System MISP |
$21.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.90
|
| Rate for Payer: United Healthcare All Other HMO |
$26.90
|
| Rate for Payer: United Healthcare HMO Rider |
$26.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.72
|
| Rate for Payer: Vantage Medical Group Senior |
$45.72
|
|
|
HC SLEEP STUDY 4 CHANNEL
|
Facility
|
IP
|
$4,014.00
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
903600038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$802.80 |
| Max. Negotiated Rate |
$3,612.60 |
| Rate for Payer: Cash Price |
$1,806.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,211.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,605.60
|
| Rate for Payer: Galaxy Health WC |
$3,411.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,408.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,612.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,677.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,529.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$802.80
|
| Rate for Payer: Multiplan Commercial |
$3,010.50
|
| Rate for Payer: Networks By Design Commercial |
$2,609.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,411.90
|
|
|
HC SLEEP STUDY 4 CHANNEL
|
Facility
|
OP
|
$4,014.00
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
903600038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$401.45 |
| Max. Negotiated Rate |
$6,702.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,464.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,352.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,371.47
|
| Rate for Payer: Blue Distinction Transplant |
$2,408.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,480.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,950.80
|
| Rate for Payer: Caremore Medicare Advantage |
$669.68
|
| Rate for Payer: Cash Price |
$1,806.30
|
| Rate for Payer: Cash Price |
$1,806.30
|
| Rate for Payer: Cash Price |
$1,806.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,211.20
|
| Rate for Payer: Cigna of CA HMO |
$2,568.96
|
| Rate for Payer: Cigna of CA PPO |
$2,970.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$3,411.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,408.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,612.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,010.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,677.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$802.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$3,010.50
|
| Rate for Payer: Networks By Design Commercial |
$2,609.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,411.90
|
| Rate for Payer: Prime Health Services Medicare |
$709.86
|
| Rate for Payer: Riverside University Health System MISP |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,408.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,408.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,702.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,698.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,497.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,113.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC SLEEP STUDY UNATTENDEDD
|
Facility
|
IP
|
$1,696.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
903600036
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
|
