|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
915350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Adventist Health Commercial |
$58.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.40
|
| Rate for Payer: Blue Shield of California Commercial |
$109.77
|
| Rate for Payer: Blue Shield of California EPN |
$71.57
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: InnovAge PACE Commercial |
$71.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$71.00
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Riverside University Health System MISP |
$56.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
905350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Adventist Health Commercial |
$58.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.40
|
| Rate for Payer: Blue Shield of California Commercial |
$109.77
|
| Rate for Payer: Blue Shield of California EPN |
$71.57
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: InnovAge PACE Commercial |
$71.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$71.00
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Riverside University Health System MISP |
$56.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC SIO W/SEMI/RIGID PLANEL PREFAB
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT L0623
|
| Hospital Charge Code |
905350623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Blue Shield of California Commercial |
$109.77
|
| Rate for Payer: Blue Shield of California EPN |
$71.57
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.29
|
| Rate for Payer: United Healthcare All Other HMO |
$51.87
|
| Rate for Payer: United Healthcare HMO Rider |
$50.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.51
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$97.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.82
|
| Rate for Payer: Blue Shield of California Commercial |
$76.48
|
| Rate for Payer: Blue Shield of California EPN |
$50.02
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.54
|
| Rate for Payer: EPIC Health Plan Senior |
$13.73
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: InnovAge PACE Commercial |
$20.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.73
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Medicare |
$14.55
|
| Rate for Payer: Riverside University Health System MISP |
$15.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
IP
|
$8,576.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,715.20 |
| Max. Negotiated Rate |
$7,718.40 |
| Rate for Payer: Adventist Health Commercial |
$1,715.20
|
| Rate for Payer: Cash Price |
$4,716.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,860.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,430.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,430.40
|
| Rate for Payer: Galaxy Health WC |
$7,289.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,145.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,718.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,720.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,308.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,715.20
|
| Rate for Payer: Multiplan Commercial |
$6,432.00
|
| Rate for Payer: Networks By Design Commercial |
$5,574.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,289.60
|
|
|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
OP
|
$8,576.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,715.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,715.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,289.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,716.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,432.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,152.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,036.68
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,716.80
|
| Rate for Payer: Cash Price |
$4,716.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,860.80
|
| Rate for Payer: Cigna of CA HMO |
$5,488.64
|
| Rate for Payer: Cigna of CA PPO |
$6,346.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,289.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,289.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,289.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,430.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,430.40
|
| Rate for Payer: Galaxy Health WC |
$7,289.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,145.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,718.40
|
| Rate for Payer: InnovAge PACE Commercial |
$4,288.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,720.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,267.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,308.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,715.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,003.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,003.20
|
| Rate for Payer: Multiplan Commercial |
$6,432.00
|
| Rate for Payer: Networks By Design Commercial |
$5,574.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,289.60
|
| Rate for Payer: Riverside University Health System MISP |
$3,430.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,289.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,289.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7,289.60
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$500.00
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$773.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.00
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$2,885.38 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$759.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,062.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$687.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$937.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,885.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$585.60
|
| Rate for Payer: Blue Shield of California Commercial |
$758.75
|
| Rate for Payer: Blue Shield of California EPN |
$496.25
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.00
|
| Rate for Payer: Cigna of CA HMO |
$800.00
|
| Rate for Payer: Cigna of CA PPO |
$925.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,062.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,062.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,062.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$500.00
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$561.05
|
| Rate for Payer: InnovAge PACE Commercial |
$625.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$773.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$875.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$875.00
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
| Rate for Payer: Riverside University Health System MISP |
$500.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$625.00
|
| Rate for Payer: United Healthcare All Other HMO |
$625.00
|
| Rate for Payer: United Healthcare HMO Rider |
$625.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$625.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,062.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,062.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,062.50
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$2,471.97 |
| Rate for Payer: Adventist Health Commercial |
$214.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$650.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$910.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$589.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$803.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,471.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$501.69
|
| Rate for Payer: Blue Shield of California Commercial |
$650.10
|
| Rate for Payer: Blue Shield of California EPN |
$425.19
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Central Health Plan Commercial |
$856.80
|
| Rate for Payer: Cigna of CA HMO |
$685.44
|
| Rate for Payer: Cigna of CA PPO |
$792.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$910.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$910.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$428.40
|
| Rate for Payer: Galaxy Health WC |
$910.35
|
| Rate for Payer: Global Benefits Group Commercial |
$642.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$963.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$480.62
|
| Rate for Payer: InnovAge PACE Commercial |
$535.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$714.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$662.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$749.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$749.70
|
| Rate for Payer: Multiplan Commercial |
$803.25
|
| Rate for Payer: Networks By Design Commercial |
$696.15
|
| Rate for Payer: Prime Health Services Commercial |
$910.35
|
| Rate for Payer: Riverside University Health System MISP |
$428.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$642.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$642.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other HMO |
$535.50
|
| Rate for Payer: United Healthcare HMO Rider |
$535.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$535.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$910.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$910.35
|
| Rate for Payer: Vantage Medical Group Senior |
$910.35
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Adventist Health Commercial |
$214.20
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Central Health Plan Commercial |
$856.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$428.40
|
| Rate for Payer: Galaxy Health WC |
$910.35
|
| Rate for Payer: Global Benefits Group Commercial |
$642.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$963.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$714.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$662.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$803.25
|
| Rate for Payer: Networks By Design Commercial |
$696.15
|
| Rate for Payer: Prime Health Services Commercial |
$910.35
|
|
|
HC SITZMARKER CAPSULE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
909009698
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.44
|
| Rate for Payer: Blue Shield of California Commercial |
$171.08
|
| Rate for Payer: Blue Shield of California EPN |
$111.72
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: InnovAge PACE Commercial |
$140.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Riverside University Health System MISP |
$112.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.00
|
| Rate for Payer: Vantage Medical Group Senior |
$238.00
|
|
|
HC SITZMARKER CAPSULE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
909009698
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Blue Shield of California Commercial |
$216.44
|
| Rate for Payer: Blue Shield of California EPN |
$141.12
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC SKIN AFFIX TOPICAL ADHESIVE
|
Facility
|
OP
|
$129.20
|
|
| Hospital Charge Code |
901607899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$116.28 |
| Rate for Payer: Adventist Health Commercial |
$25.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.88
|
| Rate for Payer: Blue Shield of California Commercial |
$78.94
|
| Rate for Payer: Blue Shield of California EPN |
$51.55
|
| Rate for Payer: Cash Price |
$71.06
|
| Rate for Payer: Central Health Plan Commercial |
$103.36
|
| Rate for Payer: Cigna of CA HMO |
$82.69
|
| Rate for Payer: Cigna of CA PPO |
$95.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.68
|
| Rate for Payer: EPIC Health Plan Senior |
$51.68
|
| Rate for Payer: Galaxy Health WC |
$109.82
|
| Rate for Payer: Global Benefits Group Commercial |
$77.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.28
|
| Rate for Payer: InnovAge PACE Commercial |
$64.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.44
|
| Rate for Payer: Multiplan Commercial |
$96.90
|
| Rate for Payer: Networks By Design Commercial |
$83.98
|
| Rate for Payer: Prime Health Services Commercial |
$109.82
|
| Rate for Payer: Riverside University Health System MISP |
$51.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.60
|
| Rate for Payer: United Healthcare All Other HMO |
$64.60
|
| Rate for Payer: United Healthcare HMO Rider |
$64.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.82
|
| Rate for Payer: Vantage Medical Group Senior |
$109.82
|
|
|
HC SKIN AFFIX TOPICAL ADHESIVE
|
Facility
|
IP
|
$129.20
|
|
| Hospital Charge Code |
901607899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$116.28 |
| Rate for Payer: Adventist Health Commercial |
$25.84
|
| Rate for Payer: Cash Price |
$71.06
|
| Rate for Payer: Central Health Plan Commercial |
$103.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.68
|
| Rate for Payer: EPIC Health Plan Senior |
$51.68
|
| Rate for Payer: Galaxy Health WC |
$109.82
|
| Rate for Payer: Global Benefits Group Commercial |
$77.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.84
|
| Rate for Payer: Multiplan Commercial |
$96.90
|
| Rate for Payer: Networks By Design Commercial |
$83.98
|
| Rate for Payer: Prime Health Services Commercial |
$109.82
|
|
|
HC SKIN BARRIER 3ML FOAM STNGFREE
|
Facility
|
OP
|
$11.97
|
|
|
Service Code
|
CPT A4369
|
| Hospital Charge Code |
901607709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.03
|
| Rate for Payer: Blue Shield of California Commercial |
$7.31
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Central Health Plan Commercial |
$9.58
|
| Rate for Payer: Cigna of CA HMO |
$7.66
|
| Rate for Payer: Cigna of CA PPO |
$8.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.79
|
| Rate for Payer: EPIC Health Plan Senior |
$4.79
|
| Rate for Payer: Galaxy Health WC |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$7.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.77
|
| Rate for Payer: InnovAge PACE Commercial |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.38
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.78
|
| Rate for Payer: Prime Health Services Commercial |
$10.17
|
| Rate for Payer: Riverside University Health System MISP |
$4.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.99
|
| Rate for Payer: United Healthcare All Other HMO |
$5.99
|
| Rate for Payer: United Healthcare HMO Rider |
$5.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.17
|
| Rate for Payer: Vantage Medical Group Senior |
$10.17
|
|
|
HC SKIN BARRIER 3ML FOAM STNGFREE
|
Facility
|
IP
|
$11.97
|
|
|
Service Code
|
CPT A4369
|
| Hospital Charge Code |
901607709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Central Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.79
|
| Rate for Payer: EPIC Health Plan Senior |
$4.79
|
| Rate for Payer: Galaxy Health WC |
$10.17
|
| Rate for Payer: Global Benefits Group Commercial |
$7.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.78
|
| Rate for Payer: Prime Health Services Commercial |
$10.17
|
|
|
HC SKIN BARRIER 3ML SUREPREP WAND
|
Facility
|
IP
|
$12.96
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Central Health Plan Commercial |
$10.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Multiplan Commercial |
$9.72
|
| Rate for Payer: Networks By Design Commercial |
$8.42
|
| Rate for Payer: Prime Health Services Commercial |
$11.02
|
|
|
HC SKIN BARRIER 3ML SUREPREP WAND
|
Facility
|
OP
|
$12.96
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698767
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Adventist Health Commercial |
$2.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.61
|
| Rate for Payer: Blue Shield of California Commercial |
$7.92
|
| Rate for Payer: Blue Shield of California EPN |
$5.17
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: Central Health Plan Commercial |
$10.37
|
| Rate for Payer: Cigna of CA HMO |
$8.29
|
| Rate for Payer: Cigna of CA PPO |
$9.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$11.02
|
| Rate for Payer: Global Benefits Group Commercial |
$7.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.66
|
| Rate for Payer: InnovAge PACE Commercial |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.07
|
| Rate for Payer: Multiplan Commercial |
$9.72
|
| Rate for Payer: Networks By Design Commercial |
$8.42
|
| Rate for Payer: Prime Health Services Commercial |
$11.02
|
| Rate for Payer: Riverside University Health System MISP |
$5.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.48
|
| Rate for Payer: United Healthcare All Other HMO |
$6.48
|
| Rate for Payer: United Healthcare HMO Rider |
$6.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.02
|
| Rate for Payer: Vantage Medical Group Senior |
$11.02
|
|
|
HC SKIN CLOSURE 1/2 X 4"
|
Facility
|
IP
|
$29.52
|
|
| Hospital Charge Code |
901605433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Adventist Health Commercial |
$5.90
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Central Health Plan Commercial |
$23.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.81
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| Rate for Payer: Galaxy Health WC |
$25.09
|
| Rate for Payer: Global Benefits Group Commercial |
$17.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$22.14
|
| Rate for Payer: Networks By Design Commercial |
$19.19
|
| Rate for Payer: Prime Health Services Commercial |
$25.09
|
|
|
HC SKIN CLOSURE 1/2 X 4"
|
Facility
|
OP
|
$29.52
|
|
| Hospital Charge Code |
901605433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Adventist Health Commercial |
$5.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.34
|
| Rate for Payer: Blue Shield of California Commercial |
$18.04
|
| Rate for Payer: Blue Shield of California EPN |
$11.78
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Central Health Plan Commercial |
$23.62
|
| Rate for Payer: Cigna of CA HMO |
$18.89
|
| Rate for Payer: Cigna of CA PPO |
$21.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.81
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| Rate for Payer: Galaxy Health WC |
$25.09
|
| Rate for Payer: Global Benefits Group Commercial |
$17.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.57
|
| Rate for Payer: InnovAge PACE Commercial |
$14.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.66
|
| Rate for Payer: Multiplan Commercial |
$22.14
|
| Rate for Payer: Networks By Design Commercial |
$19.19
|
| Rate for Payer: Prime Health Services Commercial |
$25.09
|
| Rate for Payer: Riverside University Health System MISP |
$11.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.76
|
| Rate for Payer: United Healthcare All Other HMO |
$14.76
|
| Rate for Payer: United Healthcare HMO Rider |
$14.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.09
|
| Rate for Payer: Vantage Medical Group Senior |
$25.09
|
|
|
HC SKIN CLOSURE 1/4 X 3"
|
Facility
|
OP
|
$4.10
|
|
| Hospital Charge Code |
901605431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2.51
|
| Rate for Payer: Blue Shield of California EPN |
$1.64
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: InnovAge PACE Commercial |
$2.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Riverside University Health System MISP |
$1.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC SKIN CLOSURE 1/4 X 3"
|
Facility
|
IP
|
$4.10
|
|
| Hospital Charge Code |
901605431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Central Health Plan Commercial |
$3.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.82
|
| Rate for Payer: Multiplan Commercial |
$3.08
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC SKIN CLOSURE 1/4 X 4"
|
Facility
|
OP
|
$29.77
|
|
| Hospital Charge Code |
901605432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.48
|
| Rate for Payer: Blue Shield of California Commercial |
$18.19
|
| Rate for Payer: Blue Shield of California EPN |
$11.88
|
| Rate for Payer: Cash Price |
$16.37
|
| Rate for Payer: Central Health Plan Commercial |
$23.82
|
| Rate for Payer: Cigna of CA HMO |
$19.05
|
| Rate for Payer: Cigna of CA PPO |
$22.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.79
|
| Rate for Payer: InnovAge PACE Commercial |
$14.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.84
|
| Rate for Payer: Multiplan Commercial |
$22.33
|
| Rate for Payer: Networks By Design Commercial |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
| Rate for Payer: Riverside University Health System MISP |
$11.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.30
|
| Rate for Payer: Vantage Medical Group Senior |
$25.30
|
|
|
HC SKIN CLOSURE 1/4 X 4"
|
Facility
|
IP
|
$29.77
|
|
| Hospital Charge Code |
901605432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Cash Price |
$16.37
|
| Rate for Payer: Central Health Plan Commercial |
$23.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.95
|
| Rate for Payer: Multiplan Commercial |
$22.33
|
| Rate for Payer: Networks By Design Commercial |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$25.30
|
|
