|
HC SSB
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913719
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$154.02 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.02
|
| Rate for Payer: Blue Shield of California Commercial |
$13.86
|
| Rate for Payer: Blue Shield of California Commercial |
$11.34
|
| Rate for Payer: Blue Shield of California EPN |
$8.73
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SSB AB
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$154.02 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.02
|
| Rate for Payer: Blue Shield of California Commercial |
$27.72
|
| Rate for Payer: Blue Shield of California Commercial |
$107.73
|
| Rate for Payer: Blue Shield of California EPN |
$17.47
|
| Rate for Payer: Blue Shield of California EPN |
$67.89
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SSB AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC STAINLESS/GRAPHITE PER BAR
|
Facility
|
OP
|
$360.00
|
|
| Hospital Charge Code |
905352770
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Adventist Health Commercial |
$72.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$218.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$174.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$209.41
|
| Rate for Payer: Blue Shield of California Commercial |
$228.24
|
| Rate for Payer: Blue Shield of California EPN |
$143.64
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Central Health Plan Commercial |
$288.00
|
| Rate for Payer: Cigna of CA HMO |
$230.40
|
| Rate for Payer: Cigna of CA PPO |
$266.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.00
|
| Rate for Payer: EPIC Health Plan Senior |
$144.00
|
| Rate for Payer: Galaxy Health WC |
$306.00
|
| Rate for Payer: Global Benefits Group Commercial |
$216.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$228.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$270.00
|
| Rate for Payer: Networks By Design Commercial |
$234.00
|
| Rate for Payer: Prime Health Services Commercial |
$306.00
|
| Rate for Payer: Riverside University Health System MISP |
$144.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.00
|
| Rate for Payer: United Healthcare All Other HMO |
$180.00
|
| Rate for Payer: United Healthcare HMO Rider |
$180.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.00
|
| Rate for Payer: Vantage Medical Group Senior |
$306.00
|
|
|
HC STAINLESS/GRAPHITE PER BAR
|
Facility
|
IP
|
$360.00
|
|
| Hospital Charge Code |
905352770
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Adventist Health Commercial |
$72.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Central Health Plan Commercial |
$288.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.00
|
| Rate for Payer: EPIC Health Plan Senior |
$144.00
|
| Rate for Payer: Galaxy Health WC |
$306.00
|
| Rate for Payer: Global Benefits Group Commercial |
$216.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$228.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$270.00
|
| Rate for Payer: Networks By Design Commercial |
$234.00
|
| Rate for Payer: Prime Health Services Commercial |
$306.00
|
|
|
HC STANCE PHASE ONLY
|
Facility
|
OP
|
$29,264.00
|
|
|
Service Code
|
CPT L5858
|
| Hospital Charge Code |
905355858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,583.96 |
| Max. Negotiated Rate |
$26,337.60 |
| Rate for Payer: Adventist Health Commercial |
$11,998.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,874.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,095.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,948.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,022.87
|
| Rate for Payer: Blue Shield of California Commercial |
$23,469.73
|
| Rate for Payer: Blue Shield of California EPN |
$14,749.06
|
| Rate for Payer: Cash Price |
$13,168.80
|
| Rate for Payer: Cash Price |
$13,168.80
|
| Rate for Payer: Central Health Plan Commercial |
$23,411.20
|
| Rate for Payer: Cigna of CA HMO |
$20,484.80
|
| Rate for Payer: Cigna of CA PPO |
$20,484.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,874.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,874.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,874.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,484.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,705.60
|
| Rate for Payer: Galaxy Health WC |
$24,874.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17,558.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,337.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,133.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,582.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,240.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,265.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,998.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,484.80
|
| Rate for Payer: Multiplan Commercial |
$21,948.00
|
| Rate for Payer: Networks By Design Commercial |
$14,632.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,874.40
|
| Rate for Payer: Riverside University Health System MISP |
$11,705.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,558.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,558.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,982.78
|
| Rate for Payer: United Healthcare All Other HMO |
$10,690.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10,458.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,583.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,874.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,874.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24,874.40
|
|
|
HC STANCE PHASE ONLY
|
Facility
|
IP
|
$29,264.00
|
|
|
Service Code
|
CPT L5858
|
| Hospital Charge Code |
915355858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,852.80 |
| Max. Negotiated Rate |
$26,337.60 |
| Rate for Payer: Adventist Health Commercial |
$5,852.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23,469.73
|
| Rate for Payer: Blue Shield of California EPN |
$14,749.06
|
| Rate for Payer: Cash Price |
$13,168.80
|
| Rate for Payer: Central Health Plan Commercial |
$23,411.20
|
| Rate for Payer: Cigna of CA HMO |
$20,484.80
|
| Rate for Payer: Cigna of CA PPO |
$20,484.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,484.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,705.60
|
| Rate for Payer: Galaxy Health WC |
$24,874.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17,558.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,337.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,582.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,265.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,852.80
|
| Rate for Payer: Multiplan Commercial |
$21,948.00
|
| Rate for Payer: Networks By Design Commercial |
$19,021.60
|
| Rate for Payer: Prime Health Services Commercial |
$24,874.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,982.78
|
| Rate for Payer: United Healthcare All Other HMO |
$10,690.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10,458.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,583.96
|
|
|
HC STANCE PHASE ONLY
|
Facility
|
OP
|
$29,264.00
|
|
|
Service Code
|
CPT L5858
|
| Hospital Charge Code |
915355858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,583.96 |
| Max. Negotiated Rate |
$26,337.60 |
| Rate for Payer: Adventist Health Commercial |
$11,998.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,874.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,095.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,948.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,022.87
|
| Rate for Payer: Blue Shield of California Commercial |
$23,469.73
|
| Rate for Payer: Blue Shield of California EPN |
$14,749.06
|
| Rate for Payer: Cash Price |
$13,168.80
|
| Rate for Payer: Cash Price |
$13,168.80
|
| Rate for Payer: Central Health Plan Commercial |
$23,411.20
|
| Rate for Payer: Cigna of CA HMO |
$20,484.80
|
| Rate for Payer: Cigna of CA PPO |
$20,484.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,874.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,874.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24,874.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,484.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,705.60
|
| Rate for Payer: Galaxy Health WC |
$24,874.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17,558.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,337.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,133.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,582.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22,240.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,265.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,998.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20,484.80
|
| Rate for Payer: Multiplan Commercial |
$21,948.00
|
| Rate for Payer: Networks By Design Commercial |
$14,632.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,874.40
|
| Rate for Payer: Riverside University Health System MISP |
$11,705.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,558.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,558.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,982.78
|
| Rate for Payer: United Healthcare All Other HMO |
$10,690.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10,458.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,583.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,874.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,874.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24,874.40
|
|
|
HC STANCE PHASE ONLY
|
Facility
|
IP
|
$29,264.00
|
|
|
Service Code
|
CPT L5858
|
| Hospital Charge Code |
905355858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,852.80 |
| Max. Negotiated Rate |
$26,337.60 |
| Rate for Payer: Adventist Health Commercial |
$5,852.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23,469.73
|
| Rate for Payer: Blue Shield of California EPN |
$14,749.06
|
| Rate for Payer: Cash Price |
$13,168.80
|
| Rate for Payer: Central Health Plan Commercial |
$23,411.20
|
| Rate for Payer: Cigna of CA HMO |
$20,484.80
|
| Rate for Payer: Cigna of CA PPO |
$20,484.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,484.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11,705.60
|
| Rate for Payer: Galaxy Health WC |
$24,874.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17,558.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,337.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,582.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,265.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,852.80
|
| Rate for Payer: Multiplan Commercial |
$21,948.00
|
| Rate for Payer: Networks By Design Commercial |
$19,021.60
|
| Rate for Payer: Prime Health Services Commercial |
$24,874.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,982.78
|
| Rate for Payer: United Healthcare All Other HMO |
$10,690.14
|
| Rate for Payer: United Healthcare HMO Rider |
$10,458.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,583.96
|
|
|
HC STAPHAUREX MRSA NON-BILLABLE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912440
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC STAPHAUREX MRSA NON-BILLABLE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900912440
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$47.32 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.32
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.55
|
| Rate for Payer: EPIC Health Plan Senior |
$5.70
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC STAPLER SKIN 35 W/STERILE DISP
|
Facility
|
OP
|
$89.98
|
|
| Hospital Charge Code |
901698332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$80.98 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.34
|
| Rate for Payer: Blue Shield of California Commercial |
$57.05
|
| Rate for Payer: Blue Shield of California EPN |
$35.90
|
| Rate for Payer: Cash Price |
$40.49
|
| Rate for Payer: Central Health Plan Commercial |
$71.98
|
| Rate for Payer: Cigna of CA HMO |
$57.59
|
| Rate for Payer: Cigna of CA PPO |
$66.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.99
|
| Rate for Payer: EPIC Health Plan Senior |
$35.99
|
| Rate for Payer: Galaxy Health WC |
$76.48
|
| Rate for Payer: Global Benefits Group Commercial |
$53.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.99
|
| Rate for Payer: Multiplan Commercial |
$67.48
|
| Rate for Payer: Networks By Design Commercial |
$58.49
|
| Rate for Payer: Prime Health Services Commercial |
$76.48
|
| Rate for Payer: Riverside University Health System MISP |
$35.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.99
|
| Rate for Payer: United Healthcare All Other HMO |
$44.99
|
| Rate for Payer: United Healthcare HMO Rider |
$44.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.48
|
| Rate for Payer: Vantage Medical Group Senior |
$76.48
|
|
|
HC STAPLER SKIN 35 W/STERILE DISP
|
Facility
|
IP
|
$89.98
|
|
| Hospital Charge Code |
901698332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$80.98 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$40.49
|
| Rate for Payer: Central Health Plan Commercial |
$71.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.99
|
| Rate for Payer: EPIC Health Plan Senior |
$35.99
|
| Rate for Payer: Galaxy Health WC |
$76.48
|
| Rate for Payer: Global Benefits Group Commercial |
$53.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.48
|
| Rate for Payer: Networks By Design Commercial |
$58.49
|
| Rate for Payer: Prime Health Services Commercial |
$76.48
|
|
|
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 |
$51.80 |
| Rate for Payer: Adventist Health Commercial |
$11.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.96
|
| 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 Exchange |
$27.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.48
|
| Rate for Payer: Blue Shield of California Commercial |
$36.49
|
| Rate for Payer: Blue Shield of California EPN |
$22.97
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Central Health Plan Commercial |
$46.05
|
| 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: Health Management Network EPO/PPO |
$51.80
|
| 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 |
$11.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40.29
|
| Rate for Payer: Multiplan Commercial |
$43.17
|
| Rate for Payer: Networks By Design Commercial |
$37.41
|
| Rate for Payer: Prime Health Services Commercial |
$48.93
|
| Rate for Payer: Riverside University Health System MISP |
$23.02
|
| 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 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 |
$51.80 |
| Rate for Payer: Adventist Health Commercial |
$11.51
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Central Health Plan Commercial |
$46.05
|
| 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: Health Management Network EPO/PPO |
$51.80
|
| 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 |
$11.51
|
| Rate for Payer: Multiplan Commercial |
$43.17
|
| Rate for Payer: Networks By Design Commercial |
$37.41
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$46.35 |
| Rate for Payer: Adventist Health Commercial |
$10.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.28
|
| 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 Exchange |
$24.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.96
|
| Rate for Payer: Blue Shield of California Commercial |
$32.65
|
| Rate for Payer: Blue Shield of California EPN |
$20.55
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Central Health Plan Commercial |
$41.20
|
| 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: Health Management Network EPO/PPO |
$46.35
|
| 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 |
$10.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.05
|
| Rate for Payer: Multiplan Commercial |
$38.62
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$43.77
|
| Rate for Payer: Riverside University Health System MISP |
$20.60
|
| 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 |
$46.35 |
| Rate for Payer: Adventist Health Commercial |
$10.30
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Central Health Plan Commercial |
$41.20
|
| 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: Health Management Network EPO/PPO |
$46.35
|
| 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 |
$10.30
|
| Rate for Payer: Multiplan Commercial |
$38.62
|
| Rate for Payer: Networks By Design Commercial |
$33.48
|
| Rate for Payer: Prime Health Services Commercial |
$43.77
|
|
|
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 |
$126.27 |
| Rate for Payer: Adventist Health Commercial |
$28.06
|
| Rate for Payer: Cash Price |
$63.14
|
| Rate for Payer: Central Health Plan Commercial |
$112.24
|
| 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: Health Management Network EPO/PPO |
$126.27
|
| 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 |
$28.06
|
| Rate for Payer: Multiplan Commercial |
$105.22
|
| Rate for Payer: Networks By Design Commercial |
$91.19
|
| Rate for Payer: Prime Health Services Commercial |
$119.25
|
|
|
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 |
$126.27 |
| Rate for Payer: Adventist Health Commercial |
$28.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.20
|
| 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 Exchange |
$67.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.61
|
| Rate for Payer: Blue Shield of California Commercial |
$88.95
|
| Rate for Payer: Blue Shield of California EPN |
$55.98
|
| Rate for Payer: Cash Price |
$63.14
|
| Rate for Payer: Central Health Plan Commercial |
$112.24
|
| 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: Health Management Network EPO/PPO |
$126.27
|
| 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 |
$28.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.21
|
| Rate for Payer: Multiplan Commercial |
$105.22
|
| Rate for Payer: Networks By Design Commercial |
$91.19
|
| Rate for Payer: Prime Health Services Commercial |
$119.25
|
| Rate for Payer: Riverside University Health System MISP |
$56.12
|
| 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 ROTATING 246414
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
901691013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| 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: Health Management Network EPO/PPO |
$136.80
|
| 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 |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC STAPLER SKIN ROTATING 246414
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
901691013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.31
|
| 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 Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.42
|
| Rate for Payer: Blue Shield of California Commercial |
$96.37
|
| Rate for Payer: Blue Shield of California EPN |
$60.65
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: 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: Health Management Network EPO/PPO |
$136.80
|
| 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 |
$30.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC STAPLER SKIN VISISTAT 35W DISP
|
Facility
|
OP
|
$28.62
|
|
| Hospital Charge Code |
901698691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.38
|
| 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 Exchange |
$13.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.65
|
| Rate for Payer: Blue Shield of California Commercial |
$18.15
|
| Rate for Payer: Blue Shield of California EPN |
$11.42
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| 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: Health Management Network EPO/PPO |
$25.76
|
| 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 |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.03
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
| Rate for Payer: Riverside University Health System MISP |
$11.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.31
|
| Rate for Payer: United Healthcare All Other HMO |
$14.31
|
| Rate for Payer: United Healthcare HMO Rider |
$14.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.33
|
| Rate for Payer: Vantage Medical Group Senior |
$24.33
|
|
|
HC STAPLER SKIN VISISTAT 35W DISP
|
Facility
|
IP
|
$28.62
|
|
| Hospital Charge Code |
901698691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| 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: Health Management Network EPO/PPO |
$25.76
|
| 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 |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$21.46
|
| Rate for Payer: Networks By Design Commercial |
$18.60
|
| Rate for Payer: Prime Health Services Commercial |
$24.33
|
|
|
HC STAPLER SKIN WIDE .58MM
|
Facility
|
OP
|
$38.95
|
|
| Hospital Charge Code |
901698900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$35.05 |
| Rate for Payer: Adventist Health Commercial |
$7.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.65
|
| 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 Exchange |
$18.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.66
|
| Rate for Payer: Blue Shield of California Commercial |
$24.69
|
| Rate for Payer: Blue Shield of California EPN |
$15.54
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Central Health Plan Commercial |
$31.16
|
| 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: Health Management Network EPO/PPO |
$35.05
|
| 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 |
$7.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.27
|
| Rate for Payer: Multiplan Commercial |
$29.21
|
| Rate for Payer: Networks By Design Commercial |
$25.32
|
| Rate for Payer: Prime Health Services Commercial |
$33.11
|
| Rate for Payer: Riverside University Health System MISP |
$15.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.48
|
| Rate for Payer: United Healthcare All Other HMO |
$19.48
|
| Rate for Payer: United Healthcare HMO Rider |
$19.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.11
|
| Rate for Payer: Vantage Medical Group Senior |
$33.11
|
|
|
HC STAPLER SKIN WIDE .58MM
|
Facility
|
IP
|
$38.95
|
|
| Hospital Charge Code |
901698900
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$35.05 |
| Rate for Payer: Adventist Health Commercial |
$7.79
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Central Health Plan Commercial |
$31.16
|
| 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: Health Management Network EPO/PPO |
$35.05
|
| 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 |
$7.79
|
| Rate for Payer: Multiplan Commercial |
$29.21
|
| Rate for Payer: Networks By Design Commercial |
$25.32
|
| Rate for Payer: Prime Health Services Commercial |
$33.11
|
|
