|
HC STAPHAUREX MRSA NON-BILLABLE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912440
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.22
|
| Rate for Payer: Blue Shield of California Commercial |
$33.45
|
| Rate for Payer: Blue Shield of California EPN |
$22.10
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STAPLER SKIN 35 W/STERILE DISP
|
Facility
|
IP
|
$89.98
|
|
| Hospital Charge Code |
901698332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$76.48 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.99
|
| Rate for Payer: EPIC Health Plan Senior |
$35.99
|
| Rate for Payer: Galaxy Health WC |
$76.48
|
| Rate for Payer: Global Benefits Group Commercial |
$53.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$71.98
|
| Rate for Payer: Networks By Design Commercial |
$58.49
|
| Rate for Payer: Prime Health Services Commercial |
$76.48
|
|
|
HC STAPLER SKIN 35 W/STERILE DISP
|
Facility
|
OP
|
$89.98
|
|
| Hospital Charge Code |
901698332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$76.48 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.26
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cigna of CA HMO |
$57.59
|
| Rate for Payer: Cigna of CA PPO |
$66.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.99
|
| Rate for Payer: EPIC Health Plan Senior |
$35.99
|
| Rate for Payer: Galaxy Health WC |
$76.48
|
| Rate for Payer: Global Benefits Group Commercial |
$53.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.99
|
| Rate for Payer: Multiplan Commercial |
$71.98
|
| Rate for Payer: Networks By Design Commercial |
$58.49
|
| Rate for Payer: Prime Health Services Commercial |
$76.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.99
|
| Rate for Payer: United Healthcare All Other HMO |
$44.99
|
| Rate for Payer: United Healthcare HMO Rider |
$44.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.48
|
| Rate for Payer: Vantage Medical Group Senior |
$76.48
|
|
|
HC STAPLER SKIN 4.7MM X 4.5MM
|
Facility
|
IP
|
$57.56
|
|
| Hospital Charge Code |
901698855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$48.93 |
| Rate for Payer: Adventist Health Commercial |
$11.51
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.02
|
| Rate for Payer: EPIC Health Plan Senior |
$23.02
|
| Rate for Payer: Galaxy Health WC |
$48.93
|
| Rate for Payer: Global Benefits Group Commercial |
$34.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.81
|
| Rate for Payer: Multiplan Commercial |
$46.05
|
| Rate for Payer: Networks By Design Commercial |
$37.41
|
| Rate for Payer: Prime Health Services Commercial |
$48.93
|
|
|
HC STAPLER SKIN 4.7MM X 4.5MM
|
Facility
|
OP
|
$57.56
|
|
| Hospital Charge Code |
901698855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$48.93 |
| Rate for Payer: Adventist Health Commercial |
$11.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.35
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cigna of CA HMO |
$36.84
|
| Rate for Payer: Cigna of CA PPO |
$42.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.02
|
| Rate for Payer: EPIC Health Plan Senior |
$23.02
|
| Rate for Payer: Galaxy Health WC |
$48.93
|
| Rate for Payer: Global Benefits Group Commercial |
$34.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.29
|
| Rate for Payer: Multiplan Commercial |
$46.05
|
| Rate for Payer: Networks By Design Commercial |
$37.41
|
| Rate for Payer: Prime Health Services Commercial |
$48.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.78
|
| Rate for Payer: United Healthcare All Other HMO |
$28.78
|
| Rate for Payer: United Healthcare HMO Rider |
$28.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.93
|
| Rate for Payer: Vantage Medical Group Senior |
$48.93
|
|
|
HC STAPLER SKIN PRECISE 25
|
Facility
|
OP
|
$51.50
|
|
| Hospital Charge Code |
901698556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Adventist Health Commercial |
$10.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.63
|
| Rate for Payer: Cash Price |
$28.33
|
| Rate for Payer: Cigna of CA HMO |
$32.96
|
| Rate for Payer: Cigna of CA PPO |
$38.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.60
|
| Rate for Payer: EPIC Health Plan Senior |
$20.60
|
| Rate for Payer: Galaxy Health WC |
$43.77
|
| Rate for Payer: Global Benefits Group Commercial |
$30.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.05
|
| Rate for Payer: Multiplan Commercial |
$41.20
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$43.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.75
|
| Rate for Payer: United Healthcare All Other HMO |
$25.75
|
| Rate for Payer: United Healthcare HMO Rider |
$25.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.77
|
| Rate for Payer: Vantage Medical Group Senior |
$43.77
|
|
|
HC STAPLER SKIN PRECISE 25
|
Facility
|
IP
|
$51.50
|
|
| Hospital Charge Code |
901698556
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$43.77 |
| Rate for Payer: Adventist Health Commercial |
$10.30
|
| Rate for Payer: Cash Price |
$28.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.60
|
| Rate for Payer: EPIC Health Plan Senior |
$20.60
|
| Rate for Payer: Galaxy Health WC |
$43.77
|
| Rate for Payer: Global Benefits Group Commercial |
$30.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.36
|
| Rate for Payer: Multiplan Commercial |
$41.20
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$43.77
|
|
|
HC STAPLER SKIN REGULAR .53MM
|
Facility
|
OP
|
$140.30
|
|
| Hospital Charge Code |
901698899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$119.25 |
| Rate for Payer: Adventist Health Commercial |
$28.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.16
|
| Rate for Payer: Cash Price |
$77.17
|
| Rate for Payer: Cigna of CA HMO |
$89.79
|
| Rate for Payer: Cigna of CA PPO |
$103.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.12
|
| Rate for Payer: EPIC Health Plan Senior |
$56.12
|
| Rate for Payer: Galaxy Health WC |
$119.25
|
| Rate for Payer: Global Benefits Group Commercial |
$84.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.21
|
| Rate for Payer: Multiplan Commercial |
$112.24
|
| Rate for Payer: Networks By Design Commercial |
$91.19
|
| Rate for Payer: Prime Health Services Commercial |
$119.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.15
|
| Rate for Payer: United Healthcare All Other HMO |
$70.15
|
| Rate for Payer: United Healthcare HMO Rider |
$70.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$70.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.25
|
| Rate for Payer: Vantage Medical Group Senior |
$119.25
|
|
|
HC STAPLER SKIN REGULAR .53MM
|
Facility
|
IP
|
$140.30
|
|
| Hospital Charge Code |
901698899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$119.25 |
| Rate for Payer: Adventist Health Commercial |
$28.06
|
| Rate for Payer: Cash Price |
$77.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.12
|
| Rate for Payer: EPIC Health Plan Senior |
$56.12
|
| Rate for Payer: Galaxy Health WC |
$119.25
|
| Rate for Payer: Global Benefits Group Commercial |
$84.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.67
|
| Rate for Payer: Multiplan Commercial |
$112.24
|
| Rate for Payer: Networks By Design Commercial |
$91.19
|
| Rate for Payer: Prime Health Services Commercial |
$119.25
|
|
|
HC STAPLER SKIN ROTATING 246414
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
901691013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC STAPLER SKIN ROTATING 246414
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
901691013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.34
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC STAPLER SKIN VISISTAT 35W DISP
|
Facility
|
OP
|
$28.62
|
|
| Hospital Charge Code |
901698691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$24.33 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.58
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cigna of CA HMO |
$18.32
|
| Rate for Payer: Cigna of CA PPO |
$21.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.03
|
| Rate for Payer: Multiplan Commercial |
$22.90
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.31
|
| Rate for Payer: United Healthcare All Other HMO |
$14.31
|
| Rate for Payer: United Healthcare HMO Rider |
$14.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.33
|
| Rate for Payer: Vantage Medical Group Senior |
$24.33
|
|
|
HC STAPLER SKIN VISISTAT 35W DISP
|
Facility
|
IP
|
$28.62
|
|
| Hospital Charge Code |
901698691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$24.33 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Senior |
$11.45
|
| Rate for Payer: Galaxy Health WC |
$24.33
|
| Rate for Payer: Global Benefits Group Commercial |
$17.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.87
|
| Rate for Payer: Multiplan Commercial |
$22.90
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
|
|
HC STAPLER SKIN WIDE .58MM
|
Facility
|
OP
|
$38.95
|
|
| Hospital Charge Code |
901698900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Adventist Health Commercial |
$7.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.92
|
| Rate for Payer: Cash Price |
$21.42
|
| Rate for Payer: Cigna of CA HMO |
$24.93
|
| Rate for Payer: Cigna of CA PPO |
$28.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.58
|
| Rate for Payer: EPIC Health Plan Senior |
$15.58
|
| Rate for Payer: Galaxy Health WC |
$33.11
|
| Rate for Payer: Global Benefits Group Commercial |
$23.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.27
|
| Rate for Payer: Multiplan Commercial |
$31.16
|
| Rate for Payer: Networks By Design Commercial |
$25.32
|
| Rate for Payer: Prime Health Services Commercial |
$33.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.48
|
| Rate for Payer: United Healthcare All Other HMO |
$19.48
|
| Rate for Payer: United Healthcare HMO Rider |
$19.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.11
|
| Rate for Payer: Vantage Medical Group Senior |
$33.11
|
|
|
HC STAPLER SKIN WIDE .58MM
|
Facility
|
IP
|
$38.95
|
|
| Hospital Charge Code |
901698900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$33.11 |
| Rate for Payer: Adventist Health Commercial |
$7.79
|
| Rate for Payer: Cash Price |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.58
|
| Rate for Payer: EPIC Health Plan Senior |
$15.58
|
| Rate for Payer: Galaxy Health WC |
$33.11
|
| Rate for Payer: Global Benefits Group Commercial |
$23.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$31.16
|
| Rate for Payer: Networks By Design Commercial |
$25.32
|
| Rate for Payer: Prime Health Services Commercial |
$33.11
|
|
|
HC STAPLE SKIN 15-SHOT
|
Facility
|
OP
|
$52.07
|
|
| Hospital Charge Code |
901604494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$44.26 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.98
|
| Rate for Payer: Cash Price |
$28.64
|
| Rate for Payer: Cigna of CA HMO |
$33.32
|
| Rate for Payer: Cigna of CA PPO |
$38.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$41.66
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.04
|
| Rate for Payer: United Healthcare All Other HMO |
$26.04
|
| Rate for Payer: United Healthcare HMO Rider |
$26.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.26
|
| Rate for Payer: Vantage Medical Group Senior |
$44.26
|
|
|
HC STAPLE SKIN 15-SHOT
|
Facility
|
IP
|
$52.07
|
|
| Hospital Charge Code |
901604494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$44.26 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Cash Price |
$28.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$41.66
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
|
|
HC STAPLE SKIN WIDE ETHICON
|
Facility
|
IP
|
$65.93
|
|
| Hospital Charge Code |
901605394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$56.04 |
| Rate for Payer: Adventist Health Commercial |
$13.19
|
| Rate for Payer: Cash Price |
$36.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.37
|
| Rate for Payer: EPIC Health Plan Senior |
$26.37
|
| Rate for Payer: Galaxy Health WC |
$56.04
|
| Rate for Payer: Global Benefits Group Commercial |
$39.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.82
|
| Rate for Payer: Multiplan Commercial |
$52.74
|
| Rate for Payer: Networks By Design Commercial |
$42.85
|
| Rate for Payer: Prime Health Services Commercial |
$56.04
|
|
|
HC STAPLE SKIN WIDE ETHICON
|
Facility
|
OP
|
$65.93
|
|
| Hospital Charge Code |
901605394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$56.04 |
| Rate for Payer: Adventist Health Commercial |
$13.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.49
|
| Rate for Payer: Cash Price |
$36.26
|
| Rate for Payer: Cigna of CA HMO |
$42.20
|
| Rate for Payer: Cigna of CA PPO |
$48.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.37
|
| Rate for Payer: EPIC Health Plan Senior |
$26.37
|
| Rate for Payer: Galaxy Health WC |
$56.04
|
| Rate for Payer: Global Benefits Group Commercial |
$39.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.15
|
| Rate for Payer: Multiplan Commercial |
$52.74
|
| Rate for Payer: Networks By Design Commercial |
$42.85
|
| Rate for Payer: Prime Health Services Commercial |
$56.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.97
|
| Rate for Payer: United Healthcare All Other HMO |
$32.97
|
| Rate for Payer: United Healthcare HMO Rider |
$32.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.04
|
| Rate for Payer: Vantage Medical Group Senior |
$56.04
|
|
|
HC STATSEAL BARRIER ADVANCE PWDR
|
Facility
|
IP
|
$315.84
|
|
| Hospital Charge Code |
901698651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$63.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$173.71
|
| Rate for Payer: Cash Price |
$173.71
|
| Rate for Payer: Cigna of CA HMO |
$221.09
|
| Rate for Payer: Cigna of CA PPO |
$221.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.34
|
| Rate for Payer: EPIC Health Plan Senior |
$126.34
|
| Rate for Payer: Galaxy Health WC |
$268.46
|
| Rate for Payer: Global Benefits Group Commercial |
$189.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Multiplan Commercial |
$252.67
|
| Rate for Payer: Networks By Design Commercial |
$157.92
|
| Rate for Payer: Prime Health Services Commercial |
$268.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.53
|
| Rate for Payer: United Healthcare All Other HMO |
$115.38
|
| Rate for Payer: United Healthcare HMO Rider |
$112.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.44
|
|
|
HC STATSEAL BARRIER ADVANCE PWDR
|
Facility
|
OP
|
$315.84
|
|
| Hospital Charge Code |
901698651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$268.46 |
| Rate for Payer: Adventist Health Commercial |
$63.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$268.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.93
|
| Rate for Payer: Blue Shield of California Commercial |
$233.09
|
| Rate for Payer: Blue Shield of California EPN |
$153.50
|
| Rate for Payer: Cash Price |
$173.71
|
| Rate for Payer: Cigna of CA HMO |
$221.09
|
| Rate for Payer: Cigna of CA PPO |
$221.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$268.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$268.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$268.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.34
|
| Rate for Payer: EPIC Health Plan Senior |
$126.34
|
| Rate for Payer: Galaxy Health WC |
$268.46
|
| Rate for Payer: Global Benefits Group Commercial |
$189.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.09
|
| Rate for Payer: Multiplan Commercial |
$252.67
|
| Rate for Payer: Networks By Design Commercial |
$157.92
|
| Rate for Payer: Prime Health Services Commercial |
$268.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.53
|
| Rate for Payer: United Healthcare All Other HMO |
$115.38
|
| Rate for Payer: United Healthcare HMO Rider |
$112.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$268.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$268.46
|
| Rate for Payer: Vantage Medical Group Senior |
$268.46
|
|
|
HC STATSEAL BARRIER POWDER
|
Facility
|
OP
|
$205.31
|
|
| Hospital Charge Code |
901698650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.06 |
| Max. Negotiated Rate |
$174.51 |
| Rate for Payer: Adventist Health Commercial |
$41.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.92
|
| Rate for Payer: Blue Shield of California Commercial |
$151.52
|
| Rate for Payer: Blue Shield of California EPN |
$99.78
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cigna of CA HMO |
$143.72
|
| Rate for Payer: Cigna of CA PPO |
$143.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$174.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$174.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.12
|
| Rate for Payer: EPIC Health Plan Senior |
$82.12
|
| Rate for Payer: Galaxy Health WC |
$174.51
|
| Rate for Payer: Global Benefits Group Commercial |
$123.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.72
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$102.66
|
| Rate for Payer: Prime Health Services Commercial |
$174.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.05
|
| Rate for Payer: United Healthcare All Other HMO |
$75.00
|
| Rate for Payer: United Healthcare HMO Rider |
$73.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$174.51
|
| Rate for Payer: Vantage Medical Group Senior |
$174.51
|
|
|
HC STATSEAL BARRIER POWDER
|
Facility
|
IP
|
$205.31
|
|
| Hospital Charge Code |
901698650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.06 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$41.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cash Price |
$112.92
|
| Rate for Payer: Cigna of CA HMO |
$143.72
|
| Rate for Payer: Cigna of CA PPO |
$143.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.12
|
| Rate for Payer: EPIC Health Plan Senior |
$82.12
|
| Rate for Payer: Galaxy Health WC |
$174.51
|
| Rate for Payer: Global Benefits Group Commercial |
$123.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.27
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$102.66
|
| Rate for Payer: Prime Health Services Commercial |
$174.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.05
|
| Rate for Payer: United Healthcare All Other HMO |
$75.00
|
| Rate for Payer: United Healthcare HMO Rider |
$73.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.24
|
|
|
HC STEERABLE GW
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$338.30 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
|
|
HC STEERABLE GW
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$338.30 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$298.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.41
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cigna of CA HMO |
$254.72
|
| Rate for Payer: Cigna of CA PPO |
$294.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$278.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$199.00
|
| Rate for Payer: United Healthcare All Other HMO |
$199.00
|
| Rate for Payer: United Healthcare HMO Rider |
$199.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.30
|
| Rate for Payer: Vantage Medical Group Senior |
$338.30
|
|
