|
HC TIPS TX SHEATH
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$247.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$218.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.27
|
| Rate for Payer: Blue Shield of California Commercial |
$184.49
|
| Rate for Payer: Blue Shield of California EPN |
$116.11
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Central Health Plan Commercial |
$232.80
|
| Rate for Payer: Cigna of CA HMO |
$186.24
|
| Rate for Payer: Cigna of CA PPO |
$215.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$247.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$247.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$116.40
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$203.70
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
| Rate for Payer: Riverside University Health System MISP |
$116.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.50
|
| Rate for Payer: United Healthcare All Other HMO |
$145.50
|
| Rate for Payer: United Healthcare HMO Rider |
$145.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$247.35
|
| Rate for Payer: Vantage Medical Group Senior |
$247.35
|
|
|
HC TIPS TX SHEATH
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909081695
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Central Health Plan Commercial |
$232.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$116.40
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.20
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
|
|
HC TIP SUCTION YANKAUER REG CAP
|
Facility
|
OP
|
$4.02
|
|
| Hospital Charge Code |
901605747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Central Health Plan Commercial |
$3.22
|
| Rate for Payer: Cigna of CA HMO |
$2.57
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.42
|
| Rate for Payer: Riverside University Health System MISP |
$1.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2.01
|
| Rate for Payer: United Healthcare HMO Rider |
$2.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: Vantage Medical Group Senior |
$3.42
|
|
|
HC TIP SUCTION YANKAUER REG CAP
|
Facility
|
IP
|
$4.02
|
|
| Hospital Charge Code |
901605747
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Central Health Plan Commercial |
$3.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.42
|
|
|
HC TISS CUL NEO BONE MARROW BLD
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900918003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$116.44 |
| Max. Negotiated Rate |
$1,084.47 |
| Rate for Payer: Adventist Health Commercial |
$129.60
|
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$143.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$143.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$926.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$926.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$780.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$780.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,084.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,084.47
|
| Rate for Payer: Blue Shield of California Commercial |
$469.98
|
| Rate for Payer: Blue Shield of California Commercial |
$408.24
|
| Rate for Payer: Blue Shield of California EPN |
$296.16
|
| Rate for Payer: Blue Shield of California EPN |
$257.26
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Central Health Plan Commercial |
$518.40
|
| Rate for Payer: Central Health Plan Commercial |
$596.80
|
| Rate for Payer: Cigna of CA HMO |
$477.44
|
| Rate for Payer: Cigna of CA HMO |
$414.72
|
| Rate for Payer: Cigna of CA PPO |
$552.04
|
| Rate for Payer: Cigna of CA PPO |
$479.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$453.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$522.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.19
|
| Rate for Payer: EPIC Health Plan Senior |
$158.12
|
| Rate for Payer: EPIC Health Plan Senior |
$158.12
|
| Rate for Payer: Galaxy Health WC |
$634.10
|
| Rate for Payer: Galaxy Health WC |
$550.80
|
| Rate for Payer: Global Benefits Group Commercial |
$447.60
|
| Rate for Payer: Global Benefits Group Commercial |
$388.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$671.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$583.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$235.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$235.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$411.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$192.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| Rate for Payer: Multiplan Commercial |
$486.00
|
| Rate for Payer: Networks By Design Commercial |
$421.20
|
| Rate for Payer: Networks By Design Commercial |
$484.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$143.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$143.75
|
| Rate for Payer: Prime Health Services Commercial |
$634.10
|
| Rate for Payer: Prime Health Services Commercial |
$550.80
|
| Rate for Payer: Prime Health Services Medicare |
$152.38
|
| Rate for Payer: Prime Health Services Medicare |
$152.38
|
| Rate for Payer: Riverside University Health System MISP |
$158.12
|
| Rate for Payer: Riverside University Health System MISP |
$158.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC TISS CUL NEO BONE MARROW BLD
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900918003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$671.40 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Central Health Plan Commercial |
$596.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$522.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.40
|
| Rate for Payer: EPIC Health Plan Senior |
$298.40
|
| Rate for Payer: Galaxy Health WC |
$634.10
|
| Rate for Payer: Global Benefits Group Commercial |
$447.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$671.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$440.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.20
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| Rate for Payer: Networks By Design Commercial |
$484.90
|
| Rate for Payer: Prime Health Services Commercial |
$634.10
|
|
|
HC TISS CUL NEOÂ SOLID TUMOR
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Networks By Design Commercial |
$266.50
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
|
|
HC TISS CUL NEOÂ SOLID TUMOR
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$1,443.78 |
| Rate for Payer: Adventist Health Commercial |
$59.00
|
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$147.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$147.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,082.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,082.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,038.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,038.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,443.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,443.78
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California Commercial |
$185.85
|
| Rate for Payer: Blue Shield of California EPN |
$162.77
|
| Rate for Payer: Blue Shield of California EPN |
$117.11
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Central Health Plan Commercial |
$236.00
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$262.40
|
| Rate for Payer: Cigna of CA HMO |
$188.80
|
| Rate for Payer: Cigna of CA PPO |
$303.40
|
| Rate for Payer: Cigna of CA PPO |
$218.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.41
|
| Rate for Payer: EPIC Health Plan Senior |
$162.27
|
| Rate for Payer: EPIC Health Plan Senior |
$162.27
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Galaxy Health WC |
$250.75
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Global Benefits Group Commercial |
$177.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$265.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$241.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$241.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$225.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$225.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$197.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Multiplan Commercial |
$221.25
|
| Rate for Payer: Networks By Design Commercial |
$191.75
|
| Rate for Payer: Networks By Design Commercial |
$266.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$147.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$147.52
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$250.75
|
| Rate for Payer: Prime Health Services Medicare |
$156.37
|
| Rate for Payer: Prime Health Services Medicare |
$156.37
|
| Rate for Payer: Riverside University Health System MISP |
$162.27
|
| Rate for Payer: Riverside University Health System MISP |
$162.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$147.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$147.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Central Health Plan Commercial |
$322.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$161.20
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$362.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$237.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
910408235
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$1,116.68 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$150.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,080.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$803.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,116.68
|
| Rate for Payer: Blue Shield of California Commercial |
$114.03
|
| Rate for Payer: Blue Shield of California EPN |
$71.86
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$115.84
|
| Rate for Payer: Cigna of CA PPO |
$133.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$165.33
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$150.30
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Medicare |
$159.32
|
| Rate for Payer: Riverside University Health System MISP |
$165.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$1,116.68 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$150.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$150.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,080.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,080.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$803.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$803.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,116.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,116.68
|
| Rate for Payer: Blue Shield of California Commercial |
$253.89
|
| Rate for Payer: Blue Shield of California Commercial |
$183.33
|
| Rate for Payer: Blue Shield of California EPN |
$159.99
|
| Rate for Payer: Blue Shield of California EPN |
$115.53
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Central Health Plan Commercial |
$232.80
|
| Rate for Payer: Central Health Plan Commercial |
$322.40
|
| Rate for Payer: Cigna of CA HMO |
$257.92
|
| Rate for Payer: Cigna of CA HMO |
$186.24
|
| Rate for Payer: Cigna of CA PPO |
$298.22
|
| Rate for Payer: Cigna of CA PPO |
$215.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$165.33
|
| Rate for Payer: EPIC Health Plan Senior |
$165.33
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$362.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$150.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$150.30
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
| Rate for Payer: Prime Health Services Medicare |
$159.32
|
| Rate for Payer: Prime Health Services Medicare |
$159.32
|
| Rate for Payer: Riverside University Health System MISP |
$165.33
|
| Rate for Payer: Riverside University Health System MISP |
$165.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
910408235
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$853.20 |
| Rate for Payer: Adventist Health Commercial |
$189.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Central Health Plan Commercial |
$758.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$663.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$379.20
|
| Rate for Payer: Galaxy Health WC |
$805.80
|
| Rate for Payer: Global Benefits Group Commercial |
$568.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$853.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$601.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$559.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.60
|
| Rate for Payer: Multiplan Commercial |
$711.00
|
| Rate for Payer: Networks By Design Commercial |
$616.20
|
| Rate for Payer: Prime Health Services Commercial |
$805.80
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$1,000.31 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Adventist Health Commercial |
$189.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$116.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$116.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$855.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$855.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$719.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$719.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,000.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,000.31
|
| Rate for Payer: Blue Shield of California Commercial |
$597.24
|
| Rate for Payer: Blue Shield of California Commercial |
$430.92
|
| Rate for Payer: Blue Shield of California EPN |
$376.36
|
| Rate for Payer: Blue Shield of California EPN |
$271.55
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cash Price |
$426.60
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: Central Health Plan Commercial |
$758.40
|
| Rate for Payer: Cigna of CA HMO |
$606.72
|
| Rate for Payer: Cigna of CA HMO |
$437.76
|
| Rate for Payer: Cigna of CA PPO |
$701.52
|
| Rate for Payer: Cigna of CA PPO |
$506.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$478.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$663.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.21
|
| Rate for Payer: EPIC Health Plan Senior |
$128.14
|
| Rate for Payer: EPIC Health Plan Senior |
$128.14
|
| Rate for Payer: Galaxy Health WC |
$805.80
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$568.80
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$853.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$191.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$191.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$173.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$173.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$434.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$601.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$711.00
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Networks By Design Commercial |
$616.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$116.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$116.49
|
| Rate for Payer: Prime Health Services Commercial |
$805.80
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Prime Health Services Medicare |
$123.48
|
| Rate for Payer: Prime Health Services Medicare |
$123.48
|
| Rate for Payer: Riverside University Health System MISP |
$128.14
|
| Rate for Payer: Riverside University Health System MISP |
$128.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$568.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$568.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$410.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.36
|
| Rate for Payer: United Healthcare All Other HMO |
$94.36
|
| Rate for Payer: United Healthcare All Other HMO |
$94.36
|
| Rate for Payer: United Healthcare HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$116.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$116.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$1,208.26 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$140.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$140.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,032.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,032.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$869.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$869.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,208.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,208.26
|
| Rate for Payer: Blue Shield of California Commercial |
$253.89
|
| Rate for Payer: Blue Shield of California Commercial |
$183.33
|
| Rate for Payer: Blue Shield of California EPN |
$159.99
|
| Rate for Payer: Blue Shield of California EPN |
$115.53
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Central Health Plan Commercial |
$232.80
|
| Rate for Payer: Central Health Plan Commercial |
$322.40
|
| Rate for Payer: Cigna of CA HMO |
$257.92
|
| Rate for Payer: Cigna of CA HMO |
$186.24
|
| Rate for Payer: Cigna of CA PPO |
$298.22
|
| Rate for Payer: Cigna of CA PPO |
$215.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$362.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$215.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$215.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$188.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Multiplan Commercial |
$218.25
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$140.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$140.73
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
| Rate for Payer: Prime Health Services Medicare |
$149.17
|
| Rate for Payer: Prime Health Services Medicare |
$149.17
|
| Rate for Payer: Riverside University Health System MISP |
$154.80
|
| Rate for Payer: Riverside University Health System MISP |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
|
IP
|
$403.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Adventist Health Commercial |
$80.60
|
| Rate for Payer: Cash Price |
$181.35
|
| Rate for Payer: Central Health Plan Commercial |
$322.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$161.20
|
| Rate for Payer: Galaxy Health WC |
$342.55
|
| Rate for Payer: Global Benefits Group Commercial |
$241.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$362.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$237.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.60
|
| Rate for Payer: Multiplan Commercial |
$302.25
|
| Rate for Payer: Networks By Design Commercial |
$261.95
|
| Rate for Payer: Prime Health Services Commercial |
$342.55
|
|
|
HC TISSEEL FIBRIN SEALANT/CATH
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT C2615
|
| Hospital Charge Code |
900803520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.80 |
| Max. Negotiated Rate |
$1,974.60 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,645.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,001.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,203.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,759.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,105.78
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,755.20
|
| Rate for Payer: Cigna of CA HMO |
$1,535.80
|
| Rate for Payer: Cigna of CA PPO |
$1,535.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,864.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,864.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,535.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.60
|
| Rate for Payer: EPIC Health Plan Senior |
$877.60
|
| Rate for Payer: Galaxy Health WC |
$1,864.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,974.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,393.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$796.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,294.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,535.80
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: Networks By Design Commercial |
$1,097.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.90
|
| Rate for Payer: Riverside University Health System MISP |
$877.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,316.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,316.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$823.41
|
| Rate for Payer: United Healthcare All Other HMO |
$801.47
|
| Rate for Payer: United Healthcare HMO Rider |
$784.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,864.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,864.90
|
|
|
HC TISSEEL FIBRIN SEALANT/CATH
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT C2615
|
| Hospital Charge Code |
900803520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.80 |
| Max. Negotiated Rate |
$1,974.60 |
| Rate for Payer: Adventist Health Commercial |
$438.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,759.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,105.78
|
| Rate for Payer: Cash Price |
$987.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,755.20
|
| Rate for Payer: Cigna of CA HMO |
$1,535.80
|
| Rate for Payer: Cigna of CA PPO |
$1,535.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,535.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.60
|
| Rate for Payer: EPIC Health Plan Senior |
$877.60
|
| Rate for Payer: Galaxy Health WC |
$1,864.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,974.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,393.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,294.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.80
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: Networks By Design Commercial |
$1,097.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$823.41
|
| Rate for Payer: United Healthcare All Other HMO |
$801.47
|
| Rate for Payer: United Healthcare HMO Rider |
$784.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.53
|
|
|
HC TISSUE BIOSKIN WOUND MATRIX 2X2CM
|
Facility
|
IP
|
$721.50
|
|
|
Service Code
|
CPT Q4163
|
| Hospital Charge Code |
900104419
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$649.35 |
| Rate for Payer: Adventist Health Commercial |
$144.30
|
| Rate for Payer: Blue Shield of California Commercial |
$578.64
|
| Rate for Payer: Blue Shield of California EPN |
$363.64
|
| Rate for Payer: Cash Price |
$324.68
|
| Rate for Payer: Central Health Plan Commercial |
$577.20
|
| Rate for Payer: Cigna of CA HMO |
$505.05
|
| Rate for Payer: Cigna of CA PPO |
$505.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$505.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.60
|
| Rate for Payer: EPIC Health Plan Senior |
$288.60
|
| Rate for Payer: Galaxy Health WC |
$613.27
|
| Rate for Payer: Global Benefits Group Commercial |
$432.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$649.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$458.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$425.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.30
|
| Rate for Payer: Multiplan Commercial |
$541.12
|
| Rate for Payer: Networks By Design Commercial |
$360.75
|
| Rate for Payer: Prime Health Services Commercial |
$613.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.78
|
| Rate for Payer: United Healthcare All Other HMO |
$263.56
|
| Rate for Payer: United Healthcare HMO Rider |
$257.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$236.29
|
|
|
HC TISSUE BIOSKIN WOUND MATRIX 2X2CM
|
Facility
|
OP
|
$721.50
|
|
|
Service Code
|
CPT Q4163
|
| Hospital Charge Code |
900104419
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$1,128.97 |
| Rate for Payer: Adventist Health Commercial |
$144.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,128.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$419.70
|
| Rate for Payer: Blue Shield of California Commercial |
$457.43
|
| Rate for Payer: Blue Shield of California EPN |
$287.88
|
| Rate for Payer: Cash Price |
$324.68
|
| Rate for Payer: Cash Price |
$324.68
|
| Rate for Payer: Central Health Plan Commercial |
$577.20
|
| Rate for Payer: Cigna of CA HMO |
$505.05
|
| Rate for Payer: Cigna of CA PPO |
$505.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$505.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$613.27
|
| Rate for Payer: Global Benefits Group Commercial |
$432.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$649.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$458.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$541.12
|
| Rate for Payer: Networks By Design Commercial |
$360.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$613.27
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.78
|
| Rate for Payer: United Healthcare All Other HMO |
$263.56
|
| Rate for Payer: United Healthcare HMO Rider |
$257.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$236.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC TISSUE BIOSKIN WOUND MATRIX 2X3CM
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT Q4163
|
| Hospital Charge Code |
900104418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$503.10 |
| Rate for Payer: Adventist Health Commercial |
$111.80
|
| Rate for Payer: Blue Shield of California Commercial |
$448.32
|
| Rate for Payer: Blue Shield of California EPN |
$281.74
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Central Health Plan Commercial |
$447.20
|
| Rate for Payer: Cigna of CA HMO |
$391.30
|
| Rate for Payer: Cigna of CA PPO |
$391.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$391.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: EPIC Health Plan Senior |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$503.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$354.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$329.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$209.79
|
| Rate for Payer: United Healthcare All Other HMO |
$204.20
|
| Rate for Payer: United Healthcare HMO Rider |
$199.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.07
|
|
|
HC TISSUE BIOSKIN WOUND MATRIX 2X3CM
|
Facility
|
OP
|
$559.00
|
|
|
Service Code
|
CPT Q4163
|
| Hospital Charge Code |
900104418
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$1,128.97 |
| Rate for Payer: Adventist Health Commercial |
$111.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,128.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$270.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.17
|
| Rate for Payer: Blue Shield of California Commercial |
$354.41
|
| Rate for Payer: Blue Shield of California EPN |
$223.04
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Central Health Plan Commercial |
$447.20
|
| Rate for Payer: Cigna of CA HMO |
$391.30
|
| Rate for Payer: Cigna of CA PPO |
$391.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$391.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$503.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$354.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$335.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$335.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$209.79
|
| Rate for Payer: United Healthcare All Other HMO |
$204.20
|
| Rate for Payer: United Healthcare HMO Rider |
$199.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC TISSUE BIOSKIN WOUND MATRIX 2X4CM
|
Facility
|
IP
|
$487.50
|
|
|
Service Code
|
CPT Q4163
|
| Hospital Charge Code |
900104417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Adventist Health Commercial |
$97.50
|
| Rate for Payer: Blue Shield of California Commercial |
$390.98
|
| Rate for Payer: Blue Shield of California EPN |
$245.70
|
| Rate for Payer: Cash Price |
$219.38
|
| Rate for Payer: Central Health Plan Commercial |
$390.00
|
| Rate for Payer: Cigna of CA HMO |
$341.25
|
| Rate for Payer: Cigna of CA PPO |
$341.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$341.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.00
|
| Rate for Payer: EPIC Health Plan Senior |
$195.00
|
| Rate for Payer: Galaxy Health WC |
$414.38
|
| Rate for Payer: Global Benefits Group Commercial |
$292.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$438.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$309.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$365.62
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$414.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.96
|
| Rate for Payer: United Healthcare All Other HMO |
$178.08
|
| Rate for Payer: United Healthcare HMO Rider |
$174.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.66
|
|
|
HC TISSUE BIOSKIN WOUND MATRIX 2X4CM
|
Facility
|
OP
|
$487.50
|
|
|
Service Code
|
CPT Q4163
|
| Hospital Charge Code |
900104417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$1,128.97 |
| Rate for Payer: Adventist Health Commercial |
$97.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,128.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.58
|
| Rate for Payer: Blue Shield of California Commercial |
$309.07
|
| Rate for Payer: Blue Shield of California EPN |
$194.51
|
| Rate for Payer: Cash Price |
$219.38
|
| Rate for Payer: Cash Price |
$219.38
|
| Rate for Payer: Central Health Plan Commercial |
$390.00
|
| Rate for Payer: Cigna of CA HMO |
$341.25
|
| Rate for Payer: Cigna of CA PPO |
$341.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$341.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$414.38
|
| Rate for Payer: Global Benefits Group Commercial |
$292.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$438.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$309.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$365.62
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$414.38
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.96
|
| Rate for Payer: United Healthcare All Other HMO |
$178.08
|
| Rate for Payer: United Healthcare HMO Rider |
$174.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC TISSUE BIOSKIN WOUND MATRIX 4X4CM
|
Facility
|
OP
|
$243.75
|
|
|
Service Code
|
CPT Q4163
|
| Hospital Charge Code |
900104416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$1,128.97 |
| Rate for Payer: Adventist Health Commercial |
$48.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,128.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.79
|
| Rate for Payer: Blue Shield of California Commercial |
$154.54
|
| Rate for Payer: Blue Shield of California EPN |
$97.26
|
| Rate for Payer: Cash Price |
$109.69
|
| Rate for Payer: Cash Price |
$109.69
|
| Rate for Payer: Central Health Plan Commercial |
$195.00
|
| Rate for Payer: Cigna of CA HMO |
$170.62
|
| Rate for Payer: Cigna of CA PPO |
$170.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$207.19
|
| Rate for Payer: Global Benefits Group Commercial |
$146.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$182.81
|
| Rate for Payer: Networks By Design Commercial |
$121.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$207.19
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.48
|
| Rate for Payer: United Healthcare All Other HMO |
$89.04
|
| Rate for Payer: United Healthcare HMO Rider |
$87.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
