|
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 |
$71.06
|
| 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 |
$71.06
|
| 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 |
$6.63
|
| 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 |
$6.63
|
| 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
|
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 |
$7.13
|
| 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 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 |
$7.13
|
| 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 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 |
$16.24
|
| 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 1/2 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 |
$16.24
|
| 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 1/4 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 |
$2.26
|
| 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 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 |
$2.26
|
| 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 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 |
$16.37
|
| 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 |
$16.37
|
| 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 |
$2.44
|
| 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 |
$2.44
|
| 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
|
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 |
$68.68
|
| 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 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 |
$68.68
|
| 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 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 |
$11.77
|
| 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
|
|
|
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 |
$11.77
|
| 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 PRO PASTE PHYTOPLEX 2 OZ
|
Facility
|
OP
|
$20.25
|
|
| Hospital Charge Code |
901698704
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.44
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: Cigna of CA HMO |
$12.96
|
| Rate for Payer: Cigna of CA PPO |
$14.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.12
|
| Rate for Payer: United Healthcare All Other HMO |
$10.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.21
|
| Rate for Payer: Vantage Medical Group Senior |
$17.21
|
|
|
HC SKIN PRO PASTE PHYTOPLEX 2 OZ
|
Facility
|
IP
|
$20.25
|
|
| Hospital Charge Code |
901698704
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
|
|
HC SKIN PROTECTANT CAVILON 0.7ML
|
Facility
|
OP
|
$45.92
|
|
| Hospital Charge Code |
901698453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$39.03 |
| Rate for Payer: Adventist Health Commercial |
$9.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.20
|
| Rate for Payer: Cash Price |
$25.26
|
| Rate for Payer: Cigna of CA HMO |
$29.39
|
| Rate for Payer: Cigna of CA PPO |
$33.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$39.03
|
| Rate for Payer: Global Benefits Group Commercial |
$27.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.14
|
| Rate for Payer: Multiplan Commercial |
$36.74
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.96
|
| Rate for Payer: United Healthcare All Other HMO |
$22.96
|
| Rate for Payer: United Healthcare HMO Rider |
$22.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.03
|
| Rate for Payer: Vantage Medical Group Senior |
$39.03
|
|
|
HC SKIN PROTECTANT CAVILON 0.7ML
|
Facility
|
IP
|
$45.92
|
|
| Hospital Charge Code |
901698453
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$39.03 |
| Rate for Payer: Adventist Health Commercial |
$9.18
|
| Rate for Payer: Cash Price |
$25.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$39.03
|
| Rate for Payer: Global Benefits Group Commercial |
$27.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$36.74
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.03
|
|
|
HC SKIN PROTECTNT REMEDY 2OZ PSTE
|
Facility
|
IP
|
$29.60
|
|
| Hospital Charge Code |
901698680
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$25.16 |
| Rate for Payer: Adventist Health Commercial |
$5.92
|
| Rate for Payer: Cash Price |
$16.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.84
|
| Rate for Payer: EPIC Health Plan Senior |
$11.84
|
| Rate for Payer: Galaxy Health WC |
$25.16
|
| Rate for Payer: Global Benefits Group Commercial |
$17.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.10
|
| Rate for Payer: Multiplan Commercial |
$23.68
|
| Rate for Payer: Networks By Design Commercial |
$19.24
|
| Rate for Payer: Prime Health Services Commercial |
$25.16
|
|
|
HC SKIN PROTECTNT REMEDY 2OZ PSTE
|
Facility
|
OP
|
$29.60
|
|
| Hospital Charge Code |
901698680
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$25.16 |
| Rate for Payer: Adventist Health Commercial |
$5.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.18
|
| Rate for Payer: Cash Price |
$16.28
|
| Rate for Payer: Cigna of CA HMO |
$18.94
|
| Rate for Payer: Cigna of CA PPO |
$21.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.84
|
| Rate for Payer: EPIC Health Plan Senior |
$11.84
|
| Rate for Payer: Galaxy Health WC |
$25.16
|
| Rate for Payer: Global Benefits Group Commercial |
$17.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.72
|
| Rate for Payer: Multiplan Commercial |
$23.68
|
| Rate for Payer: Networks By Design Commercial |
$19.24
|
| Rate for Payer: Prime Health Services Commercial |
$25.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.80
|
| Rate for Payer: United Healthcare All Other HMO |
$14.80
|
| Rate for Payer: United Healthcare HMO Rider |
$14.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.16
|
| Rate for Payer: Vantage Medical Group Senior |
$25.16
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
IP
|
$2,197.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.40 |
| Max. Negotiated Rate |
$1,867.45 |
| Rate for Payer: Adventist Health Commercial |
$439.40
|
| Rate for Payer: Cash Price |
$1,208.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$878.80
|
| Rate for Payer: EPIC Health Plan Senior |
$878.80
|
| Rate for Payer: Galaxy Health WC |
$1,867.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,465.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$837.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,359.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.28
|
| Rate for Payer: Multiplan Commercial |
$1,757.60
|
| Rate for Payer: Networks By Design Commercial |
$1,428.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,867.45
|
|
