|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
OP
|
$6,338.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,267.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,267.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,485.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,753.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,411.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cash Price |
$2,852.10
|
| Rate for Payer: Cigna of CA HMO |
$4,056.32
|
| Rate for Payer: Cigna of CA PPO |
$4,690.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,387.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,387.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,535.20
|
| Rate for Payer: Galaxy Health WC |
$5,387.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,802.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,227.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,414.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,923.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,436.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,436.60
|
| Rate for Payer: Multiplan Commercial |
$5,070.40
|
| Rate for Payer: Networks By Design Commercial |
$4,119.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,387.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,802.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,387.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,387.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,387.30
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
IP
|
$1,087.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.40 |
| Max. Negotiated Rate |
$923.95 |
| Rate for Payer: Adventist Health Commercial |
$217.40
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.80
|
| Rate for Payer: EPIC Health Plan Senior |
$434.80
|
| Rate for Payer: Galaxy Health WC |
$923.95
|
| Rate for Payer: Global Benefits Group Commercial |
$652.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$725.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.88
|
| Rate for Payer: Multiplan Commercial |
$869.60
|
| Rate for Payer: Networks By Design Commercial |
$706.55
|
| Rate for Payer: Prime Health Services Commercial |
$923.95
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
OP
|
$1,087.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.40 |
| Max. Negotiated Rate |
$3,917.54 |
| Rate for Payer: Adventist Health Commercial |
$217.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$923.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$597.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$815.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,917.54
|
| Rate for Payer: Blue Shield of California Commercial |
$665.24
|
| Rate for Payer: Blue Shield of California EPN |
$439.15
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: Cash Price |
$489.15
|
| Rate for Payer: Cigna of CA HMO |
$695.68
|
| Rate for Payer: Cigna of CA PPO |
$804.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$923.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$923.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.80
|
| Rate for Payer: EPIC Health Plan Senior |
$434.80
|
| Rate for Payer: Galaxy Health WC |
$923.95
|
| Rate for Payer: Global Benefits Group Commercial |
$652.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$548.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$725.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$760.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$760.90
|
| Rate for Payer: Multiplan Commercial |
$869.60
|
| Rate for Payer: Networks By Design Commercial |
$706.55
|
| Rate for Payer: Prime Health Services Commercial |
$923.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$652.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$652.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$543.50
|
| Rate for Payer: United Healthcare All Other HMO |
$543.50
|
| Rate for Payer: United Healthcare HMO Rider |
$543.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$543.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$923.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.95
|
| Rate for Payer: Vantage Medical Group Senior |
$923.95
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$792.20 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$576.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.68
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$3,356.24 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$611.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$792.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$512.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$699.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,356.24
|
| Rate for Payer: Blue Shield of California Commercial |
$570.38
|
| Rate for Payer: Blue Shield of California EPN |
$376.53
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna of CA HMO |
$596.48
|
| Rate for Payer: Cigna of CA PPO |
$689.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$792.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$792.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$792.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: EPIC Health Plan Senior |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$469.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$576.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$652.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$652.40
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$559.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.00
|
| Rate for Payer: United Healthcare All Other HMO |
$466.00
|
| Rate for Payer: United Healthcare HMO Rider |
$466.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$792.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$792.20
|
| Rate for Payer: Vantage Medical Group Senior |
$792.20
|
|
|
HC SITZMARKER CAPSULE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
909009698
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.95
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC SITZMARKER CAPSULE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
909009698
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Blue Shield of California EPN |
$136.08
|
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Blue Shield of California Commercial |
$206.64
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC SKIN AFFIX TOPICAL ADHESIVE
|
Facility
|
IP
|
$129.20
|
|
| Hospital Charge Code |
901607899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$109.82 |
| Rate for Payer: Adventist Health Commercial |
$25.84
|
| Rate for Payer: Cash Price |
$58.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.68
|
| Rate for Payer: EPIC Health Plan Senior |
$51.68
|
| Rate for Payer: Galaxy Health WC |
$109.82
|
| Rate for Payer: Global Benefits Group Commercial |
$77.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.01
|
| Rate for Payer: Multiplan Commercial |
$103.36
|
| Rate for Payer: Networks By Design Commercial |
$83.98
|
| Rate for Payer: Prime Health Services Commercial |
$109.82
|
|
|
HC SKIN AFFIX TOPICAL ADHESIVE
|
Facility
|
OP
|
$129.20
|
|
| Hospital Charge Code |
901607899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$109.82 |
| Rate for Payer: Adventist Health Commercial |
$25.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.34
|
| Rate for Payer: Cash Price |
$58.14
|
| Rate for Payer: Cigna of CA HMO |
$82.69
|
| Rate for Payer: Cigna of CA PPO |
$95.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.68
|
| Rate for Payer: EPIC Health Plan Senior |
$51.68
|
| Rate for Payer: Galaxy Health WC |
$109.82
|
| Rate for Payer: Global Benefits Group Commercial |
$77.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.44
|
| Rate for Payer: Multiplan Commercial |
$103.36
|
| Rate for Payer: Networks By Design Commercial |
$83.98
|
| Rate for Payer: Prime Health Services Commercial |
$109.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.60
|
| Rate for Payer: United Healthcare All Other HMO |
$64.60
|
| Rate for Payer: United Healthcare HMO Rider |
$64.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.82
|
| Rate for Payer: Vantage Medical Group Senior |
$109.82
|
|
|
HC SKIN BARRIER 3ML FOAM STNGFREE
|
Facility
|
IP
|
$12.05
|
|
|
Service Code
|
CPT A4369
|
| Hospital Charge Code |
901607709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$10.24 |
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: EPIC Health Plan Senior |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$10.24
|
| Rate for Payer: Global Benefits Group Commercial |
$7.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.89
|
| Rate for Payer: Multiplan Commercial |
$9.64
|
| Rate for Payer: Networks By Design Commercial |
$7.83
|
| Rate for Payer: Prime Health Services Commercial |
$10.24
|
|
|
HC SKIN BARRIER 3ML FOAM STNGFREE
|
Facility
|
OP
|
$12.05
|
|
|
Service Code
|
CPT A4369
|
| Hospital Charge Code |
901607709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$10.24 |
| Rate for Payer: Adventist Health Commercial |
$2.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.40
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cigna of CA HMO |
$7.71
|
| Rate for Payer: Cigna of CA PPO |
$8.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: EPIC Health Plan Senior |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$10.24
|
| Rate for Payer: Global Benefits Group Commercial |
$7.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$9.64
|
| Rate for Payer: Networks By Design Commercial |
$7.83
|
| Rate for Payer: Prime Health Services Commercial |
$10.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.03
|
| Rate for Payer: United Healthcare All Other HMO |
$6.03
|
| Rate for Payer: United Healthcare HMO Rider |
$6.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.24
|
| Rate for Payer: Vantage Medical Group Senior |
$10.24
|
|
|
HC SKIN BARRIER 3ML SUREPREP WAND
|
Facility
|
IP
|
$12.96
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Networks By Design Commercial |
$8.42
|
| Rate for Payer: Prime Health Services Commercial |
$11.02
|
|
|
HC SKIN BARRIER 3ML SUREPREP WAND
|
Facility
|
OP
|
$12.96
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.96
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cigna of CA HMO |
$8.29
|
| Rate for Payer: Cigna of CA PPO |
$9.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Networks By Design Commercial |
$8.42
|
| Rate for Payer: Prime Health Services Commercial |
$11.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO |
$6.48
|
| Rate for Payer: United Healthcare HMO Rider |
$6.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.02
|
| Rate for Payer: Vantage Medical Group Senior |
$11.02
|
|
|
HC SKIN CLOSURE 1/2 X 4"
|
Facility
|
IP
|
$29.52
|
|
| Hospital Charge Code |
901605433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$25.09 |
| Rate for Payer: Adventist Health Commercial |
$5.90
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.81
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| Rate for Payer: Galaxy Health WC |
$25.09
|
| Rate for Payer: Global Benefits Group Commercial |
$17.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.08
|
| Rate for Payer: Multiplan Commercial |
$23.62
|
| Rate for Payer: Networks By Design Commercial |
$19.19
|
| Rate for Payer: Prime Health Services Commercial |
$25.09
|
|
|
HC SKIN CLOSURE 1/2 X 4"
|
Facility
|
OP
|
$29.52
|
|
| Hospital Charge Code |
901605433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$25.09 |
| Rate for Payer: Adventist Health Commercial |
$5.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.13
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Cigna of CA HMO |
$18.89
|
| Rate for Payer: Cigna of CA PPO |
$21.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.81
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| Rate for Payer: Galaxy Health WC |
$25.09
|
| Rate for Payer: Global Benefits Group Commercial |
$17.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.66
|
| Rate for Payer: Multiplan Commercial |
$23.62
|
| Rate for Payer: Networks By Design Commercial |
$19.19
|
| Rate for Payer: Prime Health Services Commercial |
$25.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.76
|
| Rate for Payer: United Healthcare All Other HMO |
$14.76
|
| Rate for Payer: United Healthcare HMO Rider |
$14.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.09
|
| Rate for Payer: Vantage Medical Group Senior |
$25.09
|
|
|
HC SKIN CLOSURE 1/4 X 3"
|
Facility
|
OP
|
$4.10
|
|
| Hospital Charge Code |
901605431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.52
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC SKIN CLOSURE 1/4 X 3"
|
Facility
|
IP
|
$4.10
|
|
| Hospital Charge Code |
901605431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC SKIN CLOSURE 1/4 X 4"
|
Facility
|
IP
|
$29.77
|
|
| Hospital Charge Code |
901605432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
|
|
HC SKIN CLOSURE 1/4 X 4"
|
Facility
|
OP
|
$29.77
|
|
| Hospital Charge Code |
901605432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.28
|
| Rate for Payer: Cash Price |
$13.40
|
| Rate for Payer: Cigna of CA HMO |
$19.05
|
| Rate for Payer: Cigna of CA PPO |
$22.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.84
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
|
|
HC SKIN CLOSURE 1/8 X 3"
|
Facility
|
IP
|
$4.43
|
|
| Hospital Charge Code |
901605430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Multiplan Commercial |
$3.54
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
|
|
HC SKIN CLOSURE 1/8 X 3"
|
Facility
|
OP
|
$4.43
|
|
| Hospital Charge Code |
901605430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Adventist Health Commercial |
$0.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.72
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Cigna of CA HMO |
$2.84
|
| Rate for Payer: Cigna of CA PPO |
$3.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1.77
|
| Rate for Payer: Galaxy Health WC |
$3.77
|
| Rate for Payer: Global Benefits Group Commercial |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.10
|
| Rate for Payer: Multiplan Commercial |
$3.54
|
| Rate for Payer: Networks By Design Commercial |
$2.88
|
| Rate for Payer: Prime Health Services Commercial |
$3.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.21
|
| Rate for Payer: United Healthcare All Other HMO |
$2.21
|
| Rate for Payer: United Healthcare HMO Rider |
$2.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.77
|
| Rate for Payer: Vantage Medical Group Senior |
$3.77
|
|
|
HC SKIN CLOSURE 1 X 4"
|
Facility
|
OP
|
$124.87
|
|
| Hospital Charge Code |
901605434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$106.14 |
| Rate for Payer: Adventist Health Commercial |
$24.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.68
|
| Rate for Payer: Cash Price |
$56.19
|
| Rate for Payer: Cigna of CA HMO |
$79.92
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.95
|
| Rate for Payer: EPIC Health Plan Senior |
$49.95
|
| Rate for Payer: Galaxy Health WC |
$106.14
|
| Rate for Payer: Global Benefits Group Commercial |
$74.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.41
|
| Rate for Payer: Multiplan Commercial |
$99.90
|
| Rate for Payer: Networks By Design Commercial |
$81.17
|
| Rate for Payer: Prime Health Services Commercial |
$106.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.44
|
| Rate for Payer: United Healthcare All Other HMO |
$62.44
|
| Rate for Payer: United Healthcare HMO Rider |
$62.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.14
|
| Rate for Payer: Vantage Medical Group Senior |
$106.14
|
|
|
HC SKIN CLOSURE 1 X 4"
|
Facility
|
IP
|
$124.87
|
|
| Hospital Charge Code |
901605434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$106.14 |
| Rate for Payer: Adventist Health Commercial |
$24.97
|
| Rate for Payer: Cash Price |
$56.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.95
|
| Rate for Payer: EPIC Health Plan Senior |
$49.95
|
| Rate for Payer: Galaxy Health WC |
$106.14
|
| Rate for Payer: Global Benefits Group Commercial |
$74.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.97
|
| Rate for Payer: Multiplan Commercial |
$99.90
|
| Rate for Payer: Networks By Design Commercial |
$81.17
|
| Rate for Payer: Prime Health Services Commercial |
$106.14
|
|
|
HC SKIN CLOSURES 1" X 5"
|
Facility
|
IP
|
$21.40
|
|
| Hospital Charge Code |
901604398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: Adventist Health Commercial |
$4.28
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.56
|
| Rate for Payer: EPIC Health Plan Senior |
$8.56
|
| Rate for Payer: Galaxy Health WC |
$18.19
|
| Rate for Payer: Global Benefits Group Commercial |
$12.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Multiplan Commercial |
$17.12
|
| Rate for Payer: Networks By Design Commercial |
$13.91
|
| Rate for Payer: Prime Health Services Commercial |
$18.19
|
|
|
HC SKIN CLOSURES 1" X 5"
|
Facility
|
OP
|
$21.40
|
|
| Hospital Charge Code |
901604398
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: Adventist Health Commercial |
$4.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.14
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Cigna of CA HMO |
$13.70
|
| Rate for Payer: Cigna of CA PPO |
$15.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.56
|
| Rate for Payer: EPIC Health Plan Senior |
$8.56
|
| Rate for Payer: Galaxy Health WC |
$18.19
|
| Rate for Payer: Global Benefits Group Commercial |
$12.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.98
|
| Rate for Payer: Multiplan Commercial |
$17.12
|
| Rate for Payer: Networks By Design Commercial |
$13.91
|
| Rate for Payer: Prime Health Services Commercial |
$18.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.70
|
| Rate for Payer: United Healthcare All Other HMO |
$10.70
|
| Rate for Payer: United Healthcare HMO Rider |
$10.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.19
|
| Rate for Payer: Vantage Medical Group Senior |
$18.19
|
|
