|
HC TISS CUL NEO SOLID TUMOR
|
Facility
OP
|
$302.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$11,949.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$147.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,082.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$1,266.73
|
| Rate for Payer: BCBS Transplant Transplant |
$181.20
|
| Rate for Payer: Blue Shield of California Commercial |
$186.64
|
| Rate for Payer: Blue Shield of California EPN |
$146.77
|
| Rate for Payer: Caremore Medicare Advantage |
$147.52
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Central Health Plan Commercial |
$241.60
|
| Rate for Payer: Cigna of CA HMO |
$193.28
|
| Rate for Payer: Cigna of CA PPO |
$223.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$147.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$147.52
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$271.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$226.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$241.93
|
| Rate for Payer: IEHP medi-cal |
$243.41
|
| Rate for Payer: IEHP Medicare Advantage |
$147.52
|
| Rate for Payer: Innovage PACE Commercial |
$221.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$197.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$226.50
|
| Rate for Payer: Networks By Design Commercial |
$196.30
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
| Rate for Payer: Prime Health Services Medicare |
$156.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$181.20
|
| Rate for Payer: Riverside University Health MISP |
$162.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.20
|
| 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 HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,949.30
|
| 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 Senior |
$147.52
|
|
|
HC TISS CUL NEO SOLID TUMOR
|
Facility
IP
|
$419.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900918002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$83.80 |
| Max. Negotiated Rate |
$377.10 |
| Rate for Payer: Cash Price |
$188.55
|
| Rate for Payer: Central Health Plan Commercial |
$335.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.60
|
| Rate for Payer: Galaxy Health WC |
$356.15
|
| Rate for Payer: Global Benefits Group Commercial |
$251.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$377.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$279.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.80
|
| Rate for Payer: Multiplan Commercial |
$314.25
|
| Rate for Payer: Networks By Design Commercial |
$272.35
|
| Rate for Payer: Prime Health Services Commercial |
$356.15
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
IP
|
$412.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Central Health Plan Commercial |
$329.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$370.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.40
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC TISS CUL NON-NEO AMNIO/CHOR
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$12,174.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$150.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,080.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: AlphaCare 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 |
$979.74
|
| Rate for Payer: BCBS Transplant Transplant |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$183.55
|
| Rate for Payer: Blue Shield of California EPN |
$144.34
|
| Rate for Payer: Caremore Medicare Advantage |
$150.30
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Central Health Plan Commercial |
$237.60
|
| Rate for Payer: Cigna of CA HMO |
$190.08
|
| Rate for Payer: Cigna of CA PPO |
$219.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$150.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.30
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$267.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$222.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.49
|
| Rate for Payer: IEHP medi-cal |
$248.00
|
| Rate for Payer: IEHP Medicare Advantage |
$150.30
|
| Rate for Payer: Innovage PACE Commercial |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Prime Health Services Medicare |
$159.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: Riverside University Health MISP |
$165.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| 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 |
$12,174.30
|
| 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 LYMPHOCYTE
|
Facility
IP
|
$412.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Central Health Plan Commercial |
$329.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$370.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.40
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$9,435.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$116.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$855.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$877.64
|
| Rate for Payer: BCBS Transplant Transplant |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$183.55
|
| Rate for Payer: Blue Shield of California EPN |
$144.34
|
| Rate for Payer: Caremore Medicare Advantage |
$116.49
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Central Health Plan Commercial |
$237.60
|
| Rate for Payer: Cigna of CA HMO |
$190.08
|
| Rate for Payer: Cigna of CA PPO |
$219.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$116.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$116.49
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$267.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$222.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$191.04
|
| Rate for Payer: IEHP medi-cal |
$192.21
|
| Rate for Payer: IEHP Medicare Advantage |
$116.49
|
| Rate for Payer: Innovage PACE Commercial |
$174.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Prime Health Services Medicare |
$123.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: Riverside University Health MISP |
$128.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| 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 HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,435.60
|
| 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 Senior |
$116.49
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
IP
|
$412.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$370.80 |
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Central Health Plan Commercial |
$329.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$370.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.40
|
| Rate for Payer: Multiplan Commercial |
$309.00
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$11,399.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$140.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,032.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: AlphaCare 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 HMO/PPO |
$1,060.09
|
| Rate for Payer: BCBS Transplant Transplant |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$183.55
|
| Rate for Payer: Blue Shield of California EPN |
$144.34
|
| Rate for Payer: Caremore Medicare Advantage |
$140.73
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Central Health Plan Commercial |
$237.60
|
| Rate for Payer: Cigna of CA HMO |
$190.08
|
| Rate for Payer: Cigna of CA PPO |
$219.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$140.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.73
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$267.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$222.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: IEHP medi-cal |
$232.20
|
| Rate for Payer: IEHP Medicare Advantage |
$140.73
|
| Rate for Payer: Innovage PACE Commercial |
$211.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$222.75
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Prime Health Services Medicare |
$149.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: Riverside University Health MISP |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| 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 HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,399.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
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 |
$8,598.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,598.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,864.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,206.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,206.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,001.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,222.06
|
| Rate for Payer: BCBS Transplant Transplant |
$1,316.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,645.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,193.54
|
| Rate for Payer: Cash Price |
$987.30
|
| 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: EPIC Health Plan Commercial |
$877.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,645.50
|
| Rate for Payer: IEHP medi-cal |
$767.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.40
|
| 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: Riverside University Health 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 |
$1,097.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,097.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,097.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,097.00
|
| 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: Blue Shield of California EPN |
$1,171.60
|
| 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: EPIC Health Plan Commercial |
$877.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,463.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.80
|
| Rate for Payer: Multiplan Commercial |
$1,645.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.90
|
|
|
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: Blue Shield of California Commercial |
$541.12
|
| Rate for Payer: Blue Shield of California EPN |
$385.28
|
| 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: EPIC Health Plan Commercial |
$288.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$288.60
|
| Rate for Payer: Galaxy Health WC |
$613.28
|
| Rate for Payer: Global Benefits Group Commercial |
$432.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$649.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$481.24
|
| 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 |
$613.28
|
|
|
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 |
$1,045.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,045.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$613.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$396.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$396.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.26
|
| Rate for Payer: BCBS Transplant Transplant |
$432.90
|
| Rate for Payer: Blue Shield of California Commercial |
$453.82
|
| Rate for Payer: Blue Shield of California EPN |
$352.81
|
| 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 |
$613.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$288.60
|
| Rate for Payer: Galaxy Health WC |
$613.28
|
| Rate for Payer: Global Benefits Group Commercial |
$432.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$649.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$541.12
|
| Rate for Payer: IEHP medi-cal |
$181.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$481.24
|
| 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 |
$613.28
|
| Rate for Payer: Riverside University Health MISP |
$288.60
|
| 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 |
$360.75
|
| Rate for Payer: United Healthcare All Other HMO |
$360.75
|
| Rate for Payer: United Healthcare HMO Rider |
$360.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$613.28
|
| Rate for Payer: Vantage Medical Group Senior |
$613.28
|
|
|
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 |
$1,045.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,045.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$475.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$307.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$307.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$270.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.26
|
| Rate for Payer: BCBS Transplant Transplant |
$335.40
|
| Rate for Payer: Blue Shield of California Commercial |
$351.61
|
| Rate for Payer: Blue Shield of California EPN |
$273.35
|
| 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 |
$475.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$419.25
|
| Rate for Payer: IEHP medi-cal |
$181.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| 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: Riverside University Health MISP |
$223.60
|
| 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 |
$279.50
|
| Rate for Payer: United Healthcare All Other HMO |
$279.50
|
| Rate for Payer: United Healthcare HMO Rider |
$279.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$279.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$475.15
|
| Rate for Payer: Vantage Medical Group Senior |
$475.15
|
|
|
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: Blue Shield of California Commercial |
$419.25
|
| Rate for Payer: Blue Shield of California EPN |
$298.51
|
| 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: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$372.85
|
| 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
|
|
|
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 |
$1,045.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,045.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$414.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$268.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$268.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.02
|
| Rate for Payer: BCBS Transplant Transplant |
$292.50
|
| Rate for Payer: Blue Shield of California Commercial |
$306.64
|
| Rate for Payer: Blue Shield of California EPN |
$238.39
|
| 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 |
$414.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$365.62
|
| Rate for Payer: IEHP medi-cal |
$181.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.16
|
| 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: Riverside University Health MISP |
$195.00
|
| 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 |
$243.75
|
| Rate for Payer: United Healthcare All Other HMO |
$243.75
|
| Rate for Payer: United Healthcare HMO Rider |
$243.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.38
|
| Rate for Payer: Vantage Medical Group Senior |
$414.38
|
|
|
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: Blue Shield of California Commercial |
$365.62
|
| Rate for Payer: Blue Shield of California EPN |
$260.32
|
| 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: EPIC Health Plan Commercial |
$195.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$325.16
|
| 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
|
|
|
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 |
$1,045.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,045.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$207.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$134.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$134.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.01
|
| Rate for Payer: BCBS Transplant Transplant |
$146.25
|
| Rate for Payer: Blue Shield of California Commercial |
$153.32
|
| Rate for Payer: Blue Shield of California EPN |
$119.19
|
| 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 |
$207.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$97.50
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$182.81
|
| Rate for Payer: IEHP medi-cal |
$181.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$182.81
|
| Rate for Payer: Networks By Design Commercial |
$121.88
|
| Rate for Payer: Prime Health Services Commercial |
$207.19
|
| Rate for Payer: Riverside University Health MISP |
$97.50
|
| 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 |
$121.88
|
| Rate for Payer: United Healthcare All Other HMO |
$121.88
|
| Rate for Payer: United Healthcare HMO Rider |
$121.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.19
|
| Rate for Payer: Vantage Medical Group Senior |
$207.19
|
|
|
HC TISSUE BIOSKIN WOUND MATRIX 4X4CM
|
Facility
IP
|
$243.75
|
|
|
Service Code
|
CPT Q4163
|
| Hospital Charge Code |
900104416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$219.38 |
| Rate for Payer: Blue Shield of California Commercial |
$182.81
|
| Rate for Payer: Blue Shield of California EPN |
$130.16
|
| 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: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$97.50
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$162.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Multiplan Commercial |
$182.81
|
| Rate for Payer: Networks By Design Commercial |
$121.88
|
| Rate for Payer: Prime Health Services Commercial |
$207.19
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$52.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.21
|
| Rate for Payer: BCBS Transplant Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Caremore Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.88
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.64
|
| Rate for Payer: IEHP medi-cal |
$9.70
|
| Rate for Payer: IEHP Medicare Advantage |
$5.88
|
| Rate for Payer: Innovage PACE Commercial |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.88
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$6.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: Riverside University Health MISP |
$6.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| Rate for Payer: United Healthcare HMO Rider |
$4.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.88
|
|
|
HC TISSUE MARKER 11 GA
|
Facility
IP
|
$429.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$386.10 |
| Rate for Payer: Blue Shield of California EPN |
$229.09
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Central Health Plan Commercial |
$343.20
|
| Rate for Payer: Cigna of CA HMO |
$300.30
|
| Rate for Payer: Cigna of CA PPO |
$300.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$171.60
|
| Rate for Payer: Galaxy Health WC |
$364.65
|
| Rate for Payer: Global Benefits Group Commercial |
$257.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$386.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: Prime Health Services Commercial |
$364.65
|
|
|
HC TISSUE MARKER 11 GA
|
Facility
OP
|
$429.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$746.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$746.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$235.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$235.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$195.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.95
|
| Rate for Payer: BCBS Transplant Transplant |
$257.40
|
| Rate for Payer: Blue Shield of California Commercial |
$321.75
|
| Rate for Payer: Blue Shield of California EPN |
$233.38
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Central Health Plan Commercial |
$343.20
|
| Rate for Payer: Cigna of CA HMO |
$300.30
|
| Rate for Payer: Cigna of CA PPO |
$300.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$364.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$171.60
|
| Rate for Payer: Galaxy Health WC |
$364.65
|
| Rate for Payer: Global Benefits Group Commercial |
$257.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$386.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$321.75
|
| Rate for Payer: IEHP medi-cal |
$150.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$321.75
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$364.65
|
| Rate for Payer: Riverside University Health MISP |
$171.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$257.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$257.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$214.50
|
| Rate for Payer: United Healthcare All Other HMO |
$214.50
|
| Rate for Payer: United Healthcare HMO Rider |
$214.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Vantage Medical Group Senior |
$364.65
|
|
|
HC TISSUE MARKER 18GA
|
Facility
IP
|
$1,227.20
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$1,104.48 |
| Rate for Payer: Blue Shield of California EPN |
$655.32
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Central Health Plan Commercial |
$981.76
|
| Rate for Payer: Cigna of CA HMO |
$859.04
|
| Rate for Payer: Cigna of CA PPO |
$859.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$490.88
|
| Rate for Payer: Galaxy Health WC |
$1,043.12
|
| Rate for Payer: Global Benefits Group Commercial |
$736.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,104.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$818.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.44
|
| Rate for Payer: Multiplan Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,043.12
|
|
|
HC TISSUE MARKER 18GA
|
Facility
OP
|
$1,227.20
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001881
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$1,104.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$746.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,043.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$674.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$674.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$560.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$683.55
|
| Rate for Payer: BCBS Transplant Transplant |
$736.32
|
| Rate for Payer: Blue Shield of California Commercial |
$920.40
|
| Rate for Payer: Blue Shield of California EPN |
$667.60
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Cash Price |
$552.24
|
| Rate for Payer: Central Health Plan Commercial |
$981.76
|
| Rate for Payer: Cigna of CA HMO |
$859.04
|
| Rate for Payer: Cigna of CA PPO |
$859.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,043.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$490.88
|
| Rate for Payer: Galaxy Health WC |
$1,043.12
|
| Rate for Payer: Global Benefits Group Commercial |
$736.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,104.48
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$920.40
|
| Rate for Payer: IEHP medi-cal |
$429.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$818.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.44
|
| Rate for Payer: Multiplan Commercial |
$920.40
|
| Rate for Payer: Networks By Design Commercial |
$613.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,043.12
|
| Rate for Payer: Riverside University Health MISP |
$490.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$736.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$736.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$613.60
|
| Rate for Payer: United Healthcare All Other HMO |
$613.60
|
| Rate for Payer: United Healthcare HMO Rider |
$613.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$613.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,043.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,043.12
|
|
|
HC TISSUE MARKER 8 GA
|
Facility
IP
|
$407.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$366.30 |
| Rate for Payer: Blue Shield of California EPN |
$217.34
|
| Rate for Payer: Cash Price |
$183.15
|
| Rate for Payer: Central Health Plan Commercial |
$325.60
|
| Rate for Payer: Cigna of CA HMO |
$284.90
|
| Rate for Payer: Cigna of CA PPO |
$284.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$162.80
|
| Rate for Payer: Galaxy Health WC |
$345.95
|
| Rate for Payer: Global Benefits Group Commercial |
$244.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$366.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$271.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.40
|
| Rate for Payer: Multiplan Commercial |
$305.25
|
| Rate for Payer: Prime Health Services Commercial |
$345.95
|
|
