|
HC TISS CUL NEO 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 |
$1,038.51 |
| Rate for Payer: Adventist Health Commercial |
$59.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$147.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.15
|
| 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 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 |
$210.77
|
| Rate for Payer: Blue Shield of California Commercial |
$179.06
|
| Rate for Payer: Blue Shield of California EPN |
$117.11
|
| Rate for Payer: Cash Price |
$162.25
|
| Rate for Payer: Cash Price |
$162.25
|
| Rate for Payer: Central Health Plan Commercial |
$236.00
|
| Rate for Payer: Cigna of CA HMO |
$188.80
|
| Rate for Payer: Cigna of CA PPO |
$218.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$147.52
|
| Rate for Payer: Galaxy Health WC |
$250.75
|
| Rate for Payer: Global Benefits Group Commercial |
$177.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$265.50
|
| 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) Medicare Advantage |
$147.52
|
| Rate for Payer: InnovAge PACE Commercial |
$221.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.00
|
| 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 |
$221.25
|
| Rate for Payer: Networks By Design Commercial |
$191.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$147.52
|
| Rate for Payer: Prime Health Services Commercial |
$250.75
|
| Rate for Payer: Prime Health Services Medicare |
$156.37
|
| Rate for Payer: Riverside University Health System MISP |
$162.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.00
|
| 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 HMO |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| 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 Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
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 |
$803.22 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$150.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.72
|
| 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 |
$163.02
|
| Rate for Payer: Blue Shield of California Commercial |
$176.64
|
| Rate for Payer: Blue Shield of California EPN |
$115.53
|
| Rate for Payer: Cash Price |
$160.05
|
| Rate for Payer: Cash Price |
$160.05
|
| 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 |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.91
|
| Rate for Payer: EPIC Health Plan Senior |
$150.30
|
| 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: 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: InnovAge PACE Commercial |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.20
|
| 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 |
$218.25
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$150.30
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
| 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 |
$174.60
|
| 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 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
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900918004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Cash Price |
$160.05
|
| Rate for Payer: Central Health Plan Commercial |
$232.80
|
| 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 Permanente of CA Commercial/Self Funded |
$194.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.13
|
| 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 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 |
$719.52 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$116.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$415.39
|
| 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 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 |
$146.03
|
| Rate for Payer: Blue Shield of California Commercial |
$415.19
|
| Rate for Payer: Blue Shield of California EPN |
$271.55
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: Cigna of CA HMO |
$437.76
|
| Rate for Payer: Cigna of CA PPO |
$506.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.26
|
| Rate for Payer: EPIC Health Plan Senior |
$116.49
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| 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) Medicare Advantage |
$116.49
|
| Rate for Payer: InnovAge PACE Commercial |
$174.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| 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 |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$116.49
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Prime Health Services Medicare |
$123.48
|
| Rate for Payer: Riverside University Health System MISP |
$128.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| 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 HMO |
$94.36
|
| Rate for Payer: United Healthcare HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.36
|
| 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 Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC TISS CUL NON-NEO LYMPHOCYTE
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900918006
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Central Health Plan Commercial |
$547.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$615.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$513.00
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
|
|
HC TISS CUL NON-NEO SKN/OTH BX
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900918005
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Cash Price |
$160.05
|
| Rate for Payer: Central Health Plan Commercial |
$232.80
|
| 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 Permanente of CA Commercial/Self Funded |
$194.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.13
|
| 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 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 |
$869.10 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$140.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.72
|
| 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 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 |
$176.39
|
| Rate for Payer: Blue Shield of California Commercial |
$176.64
|
| Rate for Payer: Blue Shield of California EPN |
$115.53
|
| Rate for Payer: Cash Price |
$160.05
|
| Rate for Payer: Cash Price |
$160.05
|
| 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 |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.99
|
| Rate for Payer: EPIC Health Plan Senior |
$140.73
|
| 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: 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) Medicare Advantage |
$140.73
|
| Rate for Payer: InnovAge PACE Commercial |
$211.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.20
|
| 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 |
$218.25
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$140.73
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
| Rate for Payer: Prime Health Services Medicare |
$149.17
|
| Rate for Payer: Riverside University Health System MISP |
$154.80
|
| 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 |
$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 |
$113.99
|
| 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 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 |
$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 |
$1,214.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,695.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,105.78
|
| Rate for Payer: Cash Price |
$1,206.70
|
| 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: 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: InnovAge PACE Commercial |
$1,097.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,358.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,535.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,695.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,105.78
|
| Rate for Payer: Cash Price |
$1,206.70
|
| 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 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 Permanente of CA Commercial/Self Funded |
$1,463.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,358.09
|
| 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 |
$557.72
|
| Rate for Payer: Blue Shield of California EPN |
$363.64
|
| Rate for Payer: Cash Price |
$396.83
|
| 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 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 Permanente of CA Commercial/Self Funded |
$481.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$446.61
|
| 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 |
$649.35 |
| Rate for Payer: Adventist Health Commercial |
$144.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$438.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$613.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$541.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$423.74
|
| Rate for Payer: Blue Shield of California Commercial |
$440.84
|
| Rate for Payer: Blue Shield of California EPN |
$287.88
|
| Rate for Payer: Cash Price |
$396.83
|
| Rate for Payer: Cash Price |
$396.83
|
| 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 |
$613.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$613.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$613.27
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$182.18
|
| Rate for Payer: InnovAge PACE Commercial |
$360.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$481.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$446.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.05
|
| 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: Riverside University Health System 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 |
$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: Vantage Medical Group Commercial/Exchange |
$613.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$613.27
|
| Rate for Payer: Vantage Medical Group Senior |
$613.27
|
|
|
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 |
$503.10 |
| Rate for Payer: Adventist Health Commercial |
$111.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$307.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$419.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$270.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.30
|
| Rate for Payer: Blue Shield of California Commercial |
$341.55
|
| Rate for Payer: Blue Shield of California EPN |
$223.04
|
| Rate for Payer: Cash Price |
$307.45
|
| Rate for Payer: Cash Price |
$307.45
|
| 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: Dignity Health Medi-Cal |
$475.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$475.15
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$182.18
|
| Rate for Payer: InnovAge PACE Commercial |
$279.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$391.30
|
| 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 System 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 |
$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: Vantage Medical Group Commercial/Exchange |
$475.15
|
| 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: Adventist Health Commercial |
$111.80
|
| Rate for Payer: Blue Shield of California Commercial |
$432.11
|
| Rate for Payer: Blue Shield of California EPN |
$281.74
|
| Rate for Payer: Cash Price |
$307.45
|
| 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 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 Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.02
|
| 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 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 |
$376.84
|
| Rate for Payer: Blue Shield of California EPN |
$245.70
|
| Rate for Payer: Cash Price |
$268.12
|
| 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 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 Permanente of CA Commercial/Self Funded |
$325.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.76
|
| 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 |
$438.75 |
| Rate for Payer: Adventist Health Commercial |
$97.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$296.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286.31
|
| Rate for Payer: Blue Shield of California Commercial |
$297.86
|
| Rate for Payer: Blue Shield of California EPN |
$194.51
|
| Rate for Payer: Cash Price |
$268.12
|
| Rate for Payer: Cash Price |
$268.12
|
| 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: Dignity Health Medi-Cal |
$414.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$414.38
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$182.18
|
| Rate for Payer: InnovAge PACE Commercial |
$243.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$341.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$341.25
|
| 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 System 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 |
$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: Vantage Medical Group Commercial/Exchange |
$414.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.38
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$219.38 |
| Rate for Payer: Adventist Health Commercial |
$48.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$207.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.15
|
| Rate for Payer: Blue Shield of California Commercial |
$148.93
|
| Rate for Payer: Blue Shield of California EPN |
$97.26
|
| Rate for Payer: Cash Price |
$134.06
|
| Rate for Payer: Cash Price |
$134.06
|
| 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: Dignity Health Medi-Cal |
$207.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.50
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$182.18
|
| Rate for Payer: InnovAge PACE Commercial |
$121.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.62
|
| 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 System 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 |
$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: Vantage Medical Group Commercial/Exchange |
$207.19
|
| 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: Adventist Health Commercial |
$48.75
|
| Rate for Payer: Blue Shield of California Commercial |
$188.42
|
| Rate for Payer: Blue Shield of California EPN |
$122.85
|
| Rate for Payer: Cash Price |
$134.06
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$92.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.88
|
| 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: 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
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$20.25
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
|
|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$42.81 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Alpha Care 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 |
$8.69
|
| Rate for Payer: Blue Shield of California Commercial |
$16.39
|
| Rate for Payer: Blue Shield of California EPN |
$10.72
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Central Health Plan Commercial |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Senior |
$5.88
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.88
|
| Rate for Payer: InnovAge PACE Commercial |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| 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 |
$20.25
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.88
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Prime Health Services Medicare |
$6.23
|
| Rate for Payer: Riverside University Health System MISP |
$6.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| 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: Upland Medical Group Pediatric |
$5.88
|
| 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
|
OP
|
$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: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$235.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$195.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.54
|
| Rate for Payer: Blue Shield of California Commercial |
$331.62
|
| Rate for Payer: Blue Shield of California EPN |
$216.22
|
| Rate for Payer: Cash Price |
$235.95
|
| 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: Dignity Health Medi-Cal |
$364.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$364.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$214.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$265.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$300.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$300.30
|
| 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 System 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 |
$161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$156.71
|
| Rate for Payer: United Healthcare HMO Rider |
$153.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$364.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Vantage Medical Group Senior |
$364.65
|
|
|
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: Adventist Health Commercial |
$85.80
|
| Rate for Payer: Blue Shield of California Commercial |
$331.62
|
| Rate for Payer: Blue Shield of California EPN |
$216.22
|
| Rate for Payer: Cash Price |
$235.95
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$163.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$265.55
|
| 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: United Healthcare All Other Commercial |
$161.00
|
| Rate for Payer: United Healthcare All Other HMO |
$156.71
|
| Rate for Payer: United Healthcare HMO Rider |
$153.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.50
|
|
|
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: Adventist Health Commercial |
$245.44
|
| Rate for Payer: Blue Shield of California Commercial |
$948.63
|
| Rate for Payer: Blue Shield of California EPN |
$618.51
|
| Rate for Payer: Cash Price |
$674.96
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$467.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$759.64
|
| 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: United Healthcare All Other Commercial |
$460.57
|
| Rate for Payer: United Healthcare All Other HMO |
$448.30
|
| Rate for Payer: United Healthcare HMO Rider |
$438.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$401.91
|
|
|
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: Adventist Health Commercial |
$245.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,043.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$674.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$920.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$560.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$679.50
|
| Rate for Payer: Blue Shield of California Commercial |
$948.63
|
| Rate for Payer: Blue Shield of California EPN |
$618.51
|
| Rate for Payer: Cash Price |
$674.96
|
| 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: Dignity Health Medi-Cal |
$1,043.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,043.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$490.88
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$613.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$818.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$759.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$859.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$859.04
|
| 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 System 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 |
$460.57
|
| Rate for Payer: United Healthcare All Other HMO |
$448.30
|
| Rate for Payer: United Healthcare HMO Rider |
$438.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$401.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,043.12
|
| 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
|
OP
|
$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: Adventist Health Commercial |
$81.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$225.36
|
| Rate for Payer: Blue Shield of California Commercial |
$314.61
|
| Rate for Payer: Blue Shield of California EPN |
$205.13
|
| Rate for Payer: Cash Price |
$223.85
|
| 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: Dignity Health Commercial/Exchange |
$345.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: InnovAge PACE Commercial |
$203.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$271.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.90
|
| Rate for Payer: Multiplan Commercial |
$305.25
|
| Rate for Payer: Networks By Design Commercial |
$203.50
|
| Rate for Payer: Prime Health Services Commercial |
$345.95
|
| Rate for Payer: Riverside University Health System MISP |
$162.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.75
|
| Rate for Payer: United Healthcare All Other HMO |
$148.68
|
| Rate for Payer: United Healthcare HMO Rider |
$145.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.95
|
| Rate for Payer: Vantage Medical Group Senior |
$345.95
|
|
|
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: Adventist Health Commercial |
$81.40
|
| Rate for Payer: Blue Shield of California Commercial |
$314.61
|
| Rate for Payer: Blue Shield of California EPN |
$205.13
|
| Rate for Payer: Cash Price |
$223.85
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$155.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.40
|
| Rate for Payer: Multiplan Commercial |
$305.25
|
| Rate for Payer: Networks By Design Commercial |
$203.50
|
| Rate for Payer: Prime Health Services Commercial |
$345.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.75
|
| Rate for Payer: United Healthcare All Other HMO |
$148.68
|
| Rate for Payer: United Healthcare HMO Rider |
$145.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.29
|
|
