|
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: Multiplan Commercial |
$46.05
|
| Rate for Payer: Networks By Design Commercial |
$37.41
|
| Rate for Payer: Adventist Health Commercial |
$11.51
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.29
|
| 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 Foundation Hospitals Commercial/Self Funded |
$36.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.81
|
| 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 |
$36.94
|
| Rate for Payer: Cash Price |
$25.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.29
|
| 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 Foundation Hospitals Commercial/Self Funded |
$36.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.96
|
| 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: Networks By Design Commercial |
$33.48
|
| 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 |
$33.05
|
| Rate for Payer: Cash Price |
$23.18
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.05
|
| 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 Foundation Hospitals Commercial/Self Funded |
$32.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.39
|
| 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: 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 |
$23.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.05
|
| 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 Foundation Hospitals Commercial/Self Funded |
$32.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.39
|
| 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 |
$90.03
|
| Rate for Payer: Cash Price |
$63.14
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.21
|
| 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 Foundation Hospitals Commercial/Self Funded |
$89.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.78
|
| 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 |
$63.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.21
|
| 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 Foundation Hospitals Commercial/Self Funded |
$89.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$82.78
|
| 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
|
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 |
$97.54
|
| Rate for Payer: Cash Price |
$68.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| 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 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 |
$68.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| 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 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 |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.03
|
| 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 Foundation Hospitals Commercial/Self Funded |
$18.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.89
|
| 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 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 |
$18.37
|
| Rate for Payer: Cash Price |
$12.88
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.03
|
| 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 Foundation Hospitals Commercial/Self Funded |
$18.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.89
|
| 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 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 |
$17.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.27
|
| 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 Foundation Hospitals Commercial/Self Funded |
$24.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.98
|
| 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 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 |
$24.99
|
| Rate for Payer: Cash Price |
$17.53
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.27
|
| 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 Foundation Hospitals Commercial/Self Funded |
$24.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.98
|
| 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 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 |
$23.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.45
|
| 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 Foundation Hospitals Commercial/Self Funded |
$33.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.72
|
| 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 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 |
$33.41
|
| Rate for Payer: Cash Price |
$23.43
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.45
|
| 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 Foundation Hospitals Commercial/Self Funded |
$33.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.72
|
| 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 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 |
$42.31
|
| Rate for Payer: Cash Price |
$29.67
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.15
|
| 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 Foundation Hospitals Commercial/Self Funded |
$41.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.90
|
| 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 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 |
$29.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.15
|
| 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 Foundation Hospitals Commercial/Self Funded |
$41.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.90
|
| 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 STATSEAL BARRIER ADVANCE PWDR
|
Facility
|
IP
|
$315.84
|
|
| Hospital Charge Code |
901698651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$63.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cigna of CA HMO |
$221.09
|
| Rate for Payer: Cigna of CA PPO |
$221.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$200.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$186.35
|
| 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: Cigna of CA PPO |
$221.09
|
| 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 |
$191.18
|
| Rate for Payer: Blue Shield of California Commercial |
$160.13
|
| Rate for Payer: Blue Shield of California Commercial |
$242.88
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cigna of CA HMO |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$200.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$186.35
|
| 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
|
IP
|
$205.31
|
|
| Hospital Charge Code |
901698650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.06 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$41.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$92.39
|
| Rate for Payer: Cash Price |
$92.39
|
| Rate for Payer: Cigna of CA HMO |
$143.72
|
| Rate for Payer: Cigna of CA PPO |
$143.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$130.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$121.13
|
| 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 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 |
$124.27
|
| Rate for Payer: Blue Shield of California Commercial |
$104.09
|
| Rate for Payer: Blue Shield of California Commercial |
$157.88
|
| Rate for Payer: Cash Price |
$92.39
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$130.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$121.13
|
| 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 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 |
$179.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.82
|
| 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 |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$79.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| 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 |
$255.40
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$278.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$252.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.82
|
| 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
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
IP
|
$5,535.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947300201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$1,107.00 |
| Max. Negotiated Rate |
$4,704.75 |
| Rate for Payer: Adventist Health Commercial |
$1,107.00
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,874.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,214.00
|
| Rate for Payer: Galaxy Health WC |
$4,704.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,321.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,514.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,265.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,328.40
|
| Rate for Payer: Multiplan Commercial |
$4,428.00
|
| Rate for Payer: Networks By Design Commercial |
$3,597.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,704.75
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
OP
|
$5,535.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947300201
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$113.84 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$519.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,704.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,044.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,151.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Cigna of CA HMO |
$3,542.40
|
| Rate for Payer: Cigna of CA PPO |
$4,095.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,704.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,704.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,704.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,874.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,214.00
|
| Rate for Payer: Galaxy Health WC |
$4,704.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,321.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,514.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,265.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,328.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,874.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,874.50
|
| Rate for Payer: Multiplan Commercial |
$4,428.00
|
| Rate for Payer: Networks By Design Commercial |
$3,597.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,704.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,321.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,704.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,704.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,704.75
|
|
|
HC STEM CELL HARVEST ALLOGENIC
|
Facility
|
OP
|
$5,535.00
|
|
|
Service Code
|
CPT 38205
|
| Hospital Charge Code |
947200100
|
|
Hospital Revenue Code
|
362
|
| Min. Negotiated Rate |
$113.84 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$519.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,704.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,044.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,151.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Cash Price |
$2,490.75
|
| Rate for Payer: Cigna of CA HMO |
$3,542.40
|
| Rate for Payer: Cigna of CA PPO |
$4,095.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,704.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,704.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,704.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,874.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,214.00
|
| Rate for Payer: Galaxy Health WC |
$4,704.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,321.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,514.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,265.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,328.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,874.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,874.50
|
| Rate for Payer: Multiplan Commercial |
$4,428.00
|
| Rate for Payer: Networks By Design Commercial |
$3,597.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,704.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,321.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,704.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,704.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,704.75
|
|
