|
HC SSA AB
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913521
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$135.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$135.13
|
| Rate for Payer: BCBS Transplant Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Caremore Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: IEHP medi-cal |
$29.58
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Innovage PACE Commercial |
$26.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: Riverside University Health MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| 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 HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SSB AB
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC SSB AB
|
Facility
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913522
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$135.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$135.13
|
| Rate for Payer: BCBS Transplant Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Caremore Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: IEHP medi-cal |
$29.58
|
| Rate for Payer: IEHP Medicare Advantage |
$17.93
|
| Rate for Payer: Innovage PACE Commercial |
$26.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: Riverside University Health MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| 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 HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
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: Aetna of CA HMO/PPO |
$218.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$306.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$198.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$174.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.69
|
| Rate for Payer: BCBS Transplant Transplant |
$216.00
|
| Rate for Payer: Blue Shield of California Commercial |
$226.44
|
| Rate for Payer: Blue Shield of California EPN |
$176.04
|
| 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: EPIC Health Plan Commercial |
$144.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$270.00
|
| Rate for Payer: IEHP medi-cal |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.12
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$216.00
|
| Rate for Payer: Riverside University Health 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 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: Cash Price |
$162.00
|
| Rate for Payer: Central Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$240.12
|
| 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
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: Blue Shield of California EPN |
$15,626.98
|
| 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: EPIC Health Plan Commercial |
$11,705.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$19,519.09
|
| 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 |
$14,632.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,874.40
|
|
|
HC STANCE PHASE ONLY
|
Facility
OP
|
$29,264.00
|
|
|
Service Code
|
CPT L5858
|
| Hospital Charge Code |
905355858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10,242.40 |
| Max. Negotiated Rate |
$73,860.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$73,860.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24,874.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16,095.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16,095.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,169.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,289.17
|
| Rate for Payer: BCBS Transplant Transplant |
$17,558.40
|
| Rate for Payer: Blue Shield of California Commercial |
$21,948.00
|
| Rate for Payer: Blue Shield of California EPN |
$15,919.62
|
| 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: EPIC Health Plan Commercial |
$11,705.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$21,948.00
|
| Rate for Payer: IEHP medi-cal |
$10,242.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,519.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,998.24
|
| 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 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 |
$14,632.00
|
| Rate for Payer: United Healthcare All Other HMO |
$14,632.00
|
| Rate for Payer: United Healthcare HMO Rider |
$14,632.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,632.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,874.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24,874.40
|
|
|
HC STAPLER SKIN 35 W/STERILE DISP
|
Facility
OP
|
$54.61
|
|
| Hospital Charge Code |
901698332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$49.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$33.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.26
|
| Rate for Payer: BCBS Transplant Transplant |
$32.77
|
| Rate for Payer: Blue Shield of California Commercial |
$34.35
|
| Rate for Payer: Blue Shield of California EPN |
$26.70
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Central Health Plan Commercial |
$43.69
|
| Rate for Payer: Cigna of CA HMO |
$34.95
|
| Rate for Payer: Cigna of CA PPO |
$40.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.84
|
| Rate for Payer: Galaxy Health WC |
$46.42
|
| Rate for Payer: Global Benefits Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.96
|
| Rate for Payer: IEHP medi-cal |
$19.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Multiplan Commercial |
$40.96
|
| Rate for Payer: Networks By Design Commercial |
$35.50
|
| Rate for Payer: Prime Health Services Commercial |
$46.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$32.77
|
| Rate for Payer: Riverside University Health MISP |
$21.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.30
|
| Rate for Payer: United Healthcare All Other HMO |
$27.30
|
| Rate for Payer: United Healthcare HMO Rider |
$27.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.42
|
| Rate for Payer: Vantage Medical Group Senior |
$46.42
|
|
|
HC STAPLER SKIN 35 W/STERILE DISP
|
Facility
IP
|
$54.61
|
|
| Hospital Charge Code |
901698332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$49.15 |
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Central Health Plan Commercial |
$43.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.84
|
| Rate for Payer: Galaxy Health WC |
$46.42
|
| Rate for Payer: Global Benefits Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Multiplan Commercial |
$40.96
|
| Rate for Payer: Networks By Design Commercial |
$35.50
|
| Rate for Payer: Prime Health Services Commercial |
$46.42
|
|
|
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: Aetna of CA HMO/PPO |
$31.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.43
|
| Rate for Payer: BCBS Transplant Transplant |
$30.90
|
| Rate for Payer: Blue Shield of California Commercial |
$32.39
|
| Rate for Payer: Blue Shield of California EPN |
$25.18
|
| 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 |
$43.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.60
|
| Rate for Payer: Galaxy Health WC |
$43.78
|
| Rate for Payer: Global Benefits Group Commercial |
$30.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$38.62
|
| Rate for Payer: IEHP medi-cal |
$18.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.35
|
| 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 |
$43.78
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.90
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$43.78
|
| Rate for Payer: Vantage Medical Group Senior |
$43.78
|
|
|
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: Cash Price |
$23.18
|
| Rate for Payer: Central Health Plan Commercial |
$41.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.60
|
| Rate for Payer: Galaxy Health WC |
$43.78
|
| Rate for Payer: Global Benefits Group Commercial |
$30.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.35
|
| 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 |
$43.78
|
|
|
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: Aetna of CA HMO/PPO |
$92.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$83.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.80
|
| Rate for Payer: BCBS Transplant Transplant |
$91.20
|
| Rate for Payer: Blue Shield of California Commercial |
$95.61
|
| Rate for Payer: Blue Shield of California EPN |
$74.33
|
| 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: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$114.00
|
| Rate for Payer: IEHP medi-cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC STAPLER SKIN ROTATING 246414
|
Facility
IP
|
$152.00
|
|
| Hospital Charge Code |
901691013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$101.38
|
| 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 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: Aetna of CA HMO/PPO |
$17.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.33
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.91
|
| Rate for Payer: BCBS Transplant Transplant |
$17.17
|
| Rate for Payer: Blue Shield of California Commercial |
$18.00
|
| Rate for Payer: Blue Shield of California EPN |
$14.00
|
| 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: EPIC Health Plan Commercial |
$11.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$21.46
|
| Rate for Payer: IEHP medi-cal |
$10.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.09
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$17.17
|
| Rate for Payer: Riverside University Health 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 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: Cash Price |
$12.88
|
| Rate for Payer: Central Health Plan Commercial |
$22.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$19.09
|
| 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 STAPLE SKIN 15-SHOT
|
Facility
OP
|
$39.03
|
|
| Hospital Charge Code |
901604494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$35.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.06
|
| Rate for Payer: BCBS Transplant Transplant |
$23.42
|
| Rate for Payer: Blue Shield of California Commercial |
$24.55
|
| Rate for Payer: Blue Shield of California EPN |
$19.09
|
| Rate for Payer: Cash Price |
$17.56
|
| Rate for Payer: Central Health Plan Commercial |
$31.22
|
| Rate for Payer: Cigna of CA HMO |
$24.98
|
| Rate for Payer: Cigna of CA PPO |
$28.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.61
|
| Rate for Payer: Galaxy Health WC |
$33.18
|
| Rate for Payer: Global Benefits Group Commercial |
$23.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.27
|
| Rate for Payer: IEHP medi-cal |
$13.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.81
|
| Rate for Payer: Multiplan Commercial |
$29.27
|
| Rate for Payer: Networks By Design Commercial |
$25.37
|
| Rate for Payer: Prime Health Services Commercial |
$33.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23.42
|
| Rate for Payer: Riverside University Health MISP |
$15.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.52
|
| Rate for Payer: United Healthcare All Other HMO |
$19.52
|
| Rate for Payer: United Healthcare HMO Rider |
$19.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.18
|
| Rate for Payer: Vantage Medical Group Senior |
$33.18
|
|
|
HC STAPLE SKIN 15-SHOT
|
Facility
IP
|
$39.03
|
|
| Hospital Charge Code |
901604494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$35.13 |
| Rate for Payer: Cash Price |
$17.56
|
| Rate for Payer: Central Health Plan Commercial |
$31.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.61
|
| Rate for Payer: Galaxy Health WC |
$33.18
|
| Rate for Payer: Global Benefits Group Commercial |
$23.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.81
|
| Rate for Payer: Multiplan Commercial |
$29.27
|
| Rate for Payer: Networks By Design Commercial |
$25.37
|
| Rate for Payer: Prime Health Services Commercial |
$33.18
|
|
|
HC STAPLE SKIN WIDE ETHICON
|
Facility
IP
|
$52.89
|
|
| Hospital Charge Code |
901605394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: Central Health Plan Commercial |
$42.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.16
|
| Rate for Payer: Galaxy Health WC |
$44.96
|
| Rate for Payer: Global Benefits Group Commercial |
$31.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$39.67
|
| Rate for Payer: Networks By Design Commercial |
$34.38
|
| Rate for Payer: Prime Health Services Commercial |
$44.96
|
|
|
HC STAPLE SKIN WIDE ETHICON
|
Facility
OP
|
$52.89
|
|
| Hospital Charge Code |
901605394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.09
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.25
|
| Rate for Payer: BCBS Transplant Transplant |
$31.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.27
|
| Rate for Payer: Blue Shield of California EPN |
$25.86
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: Central Health Plan Commercial |
$42.31
|
| Rate for Payer: Cigna of CA HMO |
$33.85
|
| Rate for Payer: Cigna of CA PPO |
$39.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.16
|
| Rate for Payer: Galaxy Health WC |
$44.96
|
| Rate for Payer: Global Benefits Group Commercial |
$31.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.67
|
| Rate for Payer: IEHP medi-cal |
$18.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.58
|
| Rate for Payer: Multiplan Commercial |
$39.67
|
| Rate for Payer: Networks By Design Commercial |
$34.38
|
| Rate for Payer: Prime Health Services Commercial |
$44.96
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.73
|
| Rate for Payer: Riverside University Health MISP |
$21.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.44
|
| Rate for Payer: United Healthcare All Other HMO |
$26.44
|
| Rate for Payer: United Healthcare HMO Rider |
$26.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.96
|
| Rate for Payer: Vantage Medical Group Senior |
$44.96
|
|
|
HC STATSEAL BARRIER ADVANCE PWDR
|
Facility
IP
|
$271.81
|
|
| Hospital Charge Code |
901698651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.36 |
| Max. Negotiated Rate |
$244.63 |
| Rate for Payer: Blue Shield of California EPN |
$145.15
|
| Rate for Payer: Cash Price |
$122.31
|
| Rate for Payer: Central Health Plan Commercial |
$217.45
|
| Rate for Payer: Cigna of CA HMO |
$190.27
|
| Rate for Payer: Cigna of CA PPO |
$190.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$108.72
|
| Rate for Payer: Galaxy Health WC |
$231.04
|
| Rate for Payer: Global Benefits Group Commercial |
$163.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.36
|
| Rate for Payer: Multiplan Commercial |
$203.86
|
| Rate for Payer: Prime Health Services Commercial |
$231.04
|
|
|
HC STATSEAL BARRIER ADVANCE PWDR
|
Facility
OP
|
$271.81
|
|
| Hospital Charge Code |
901698651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.36 |
| Max. Negotiated Rate |
$244.63 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$231.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$149.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$149.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.40
|
| Rate for Payer: BCBS Transplant Transplant |
$163.09
|
| Rate for Payer: Blue Shield of California Commercial |
$203.86
|
| Rate for Payer: Blue Shield of California EPN |
$147.86
|
| Rate for Payer: Cash Price |
$122.31
|
| Rate for Payer: Cash Price |
$122.31
|
| Rate for Payer: Central Health Plan Commercial |
$217.45
|
| Rate for Payer: Cigna of CA HMO |
$190.27
|
| Rate for Payer: Cigna of CA PPO |
$190.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$108.72
|
| Rate for Payer: Galaxy Health WC |
$231.04
|
| Rate for Payer: Global Benefits Group Commercial |
$163.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$203.86
|
| Rate for Payer: IEHP medi-cal |
$95.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.36
|
| Rate for Payer: Multiplan Commercial |
$203.86
|
| Rate for Payer: Networks By Design Commercial |
$135.90
|
| Rate for Payer: Prime Health Services Commercial |
$231.04
|
| Rate for Payer: Riverside University Health MISP |
$108.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.90
|
| Rate for Payer: United Healthcare All Other HMO |
$135.90
|
| Rate for Payer: United Healthcare HMO Rider |
$135.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.04
|
| Rate for Payer: Vantage Medical Group Senior |
$231.04
|
|
|
HC STATSEAL BARRIER POWDER
|
Facility
IP
|
$176.68
|
|
| Hospital Charge Code |
901698650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$159.01 |
| Rate for Payer: Blue Shield of California EPN |
$94.35
|
| Rate for Payer: Cash Price |
$79.51
|
| Rate for Payer: Central Health Plan Commercial |
$141.34
|
| Rate for Payer: Cigna of CA HMO |
$123.68
|
| Rate for Payer: Cigna of CA PPO |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$70.67
|
| Rate for Payer: Galaxy Health WC |
$150.18
|
| Rate for Payer: Global Benefits Group Commercial |
$106.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.34
|
| Rate for Payer: Multiplan Commercial |
$132.51
|
| Rate for Payer: Prime Health Services Commercial |
$150.18
|
|
|
HC STATSEAL BARRIER POWDER
|
Facility
OP
|
$176.68
|
|
| Hospital Charge Code |
901698650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$159.01 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$150.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$97.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$97.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.41
|
| Rate for Payer: BCBS Transplant Transplant |
$106.01
|
| Rate for Payer: Blue Shield of California Commercial |
$132.51
|
| Rate for Payer: Blue Shield of California EPN |
$96.11
|
| Rate for Payer: Cash Price |
$79.51
|
| Rate for Payer: Cash Price |
$79.51
|
| Rate for Payer: Central Health Plan Commercial |
$141.34
|
| Rate for Payer: Cigna of CA HMO |
$123.68
|
| Rate for Payer: Cigna of CA PPO |
$123.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$70.67
|
| Rate for Payer: Galaxy Health WC |
$150.18
|
| Rate for Payer: Global Benefits Group Commercial |
$106.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$132.51
|
| Rate for Payer: IEHP medi-cal |
$61.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.34
|
| Rate for Payer: Multiplan Commercial |
$132.51
|
| Rate for Payer: Networks By Design Commercial |
$88.34
|
| Rate for Payer: Prime Health Services Commercial |
$150.18
|
| Rate for Payer: Riverside University Health MISP |
$70.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.34
|
| Rate for Payer: United Healthcare All Other HMO |
$88.34
|
| Rate for Payer: United Healthcare HMO Rider |
$88.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.18
|
| Rate for Payer: Vantage Medical Group Senior |
$150.18
|
|
|
HC STEERABLE GW
|
Facility
OP
|
$398.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$338.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$218.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$218.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$192.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.14
|
| Rate for Payer: BCBS Transplant Transplant |
$238.80
|
| Rate for Payer: Blue Shield of California Commercial |
$250.34
|
| Rate for Payer: Blue Shield of California EPN |
$194.62
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Central Health Plan Commercial |
$318.40
|
| Rate for Payer: Cigna of CA HMO |
$254.72
|
| Rate for Payer: Cigna of CA PPO |
$294.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$358.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$298.50
|
| Rate for Payer: IEHP medi-cal |
$139.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.60
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$238.80
|
| Rate for Payer: Riverside University Health MISP |
$159.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$199.00
|
| Rate for Payer: United Healthcare All Other HMO |
$199.00
|
| Rate for Payer: United Healthcare HMO Rider |
$199.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.30
|
| Rate for Payer: Vantage Medical Group Senior |
$338.30
|
|
|
HC STEERABLE GW
|
Facility
IP
|
$398.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081227
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.60 |
| Max. Negotiated Rate |
$358.20 |
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Central Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.20
|
| Rate for Payer: Galaxy Health WC |
$338.30
|
| Rate for Payer: Global Benefits Group Commercial |
$238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$358.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.60
|
| Rate for Payer: Multiplan Commercial |
$298.50
|
| Rate for Payer: Networks By Design Commercial |
$258.70
|
| Rate for Payer: Prime Health Services Commercial |
$338.30
|
|
