|
HC WOUND CLOSURE BY ADHESIVE
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
902890217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Adventist Health Commercial |
$57.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.78
|
| Rate for Payer: Blue Shield of California Commercial |
$180.69
|
| Rate for Payer: Blue Shield of California EPN |
$113.72
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Central Health Plan Commercial |
$228.00
|
| Rate for Payer: Cigna of CA HMO |
$182.40
|
| Rate for Payer: Cigna of CA PPO |
$210.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$242.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$242.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$242.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$199.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: EPIC Health Plan Senior |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$180.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$168.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$199.50
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
| Rate for Payer: Riverside University Health System MISP |
$114.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.50
|
| Rate for Payer: United Healthcare All Other HMO |
$142.50
|
| Rate for Payer: United Healthcare HMO Rider |
$142.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.25
|
| Rate for Payer: Vantage Medical Group Senior |
$242.25
|
|
|
HC WOUND CLOSURE BY ADHESIVE
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
902890217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Adventist Health Commercial |
$57.00
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Central Health Plan Commercial |
$228.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$199.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: EPIC Health Plan Senior |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$180.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$168.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
|
|
HC WOUND CLOSURE STRIP .5X4IN
|
Facility
|
IP
|
$6.15
|
|
| Hospital Charge Code |
901698703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Central Health Plan Commercial |
$4.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.61
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
|
|
HC WOUND CLOSURE STRIP .5X4IN
|
Facility
|
OP
|
$6.15
|
|
| Hospital Charge Code |
901698703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Central Health Plan Commercial |
$4.92
|
| Rate for Payer: Cigna of CA HMO |
$3.94
|
| Rate for Payer: Cigna of CA PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$4.61
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
| Rate for Payer: Riverside University Health System MISP |
$2.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Vantage Medical Group Senior |
$5.23
|
|
|
HC WOUND CROWN- FISTULA MGMT
|
Facility
|
OP
|
$382.80
|
|
| Hospital Charge Code |
901608082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.52 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$325.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$210.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.67
|
| Rate for Payer: Blue Shield of California Commercial |
$242.70
|
| Rate for Payer: Blue Shield of California EPN |
$152.74
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.24
|
| Rate for Payer: Cigna of CA HMO |
$244.99
|
| Rate for Payer: Cigna of CA PPO |
$283.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$325.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$325.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$267.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Senior |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.38
|
| Rate for Payer: Global Benefits Group Commercial |
$229.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$138.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$267.96
|
| Rate for Payer: Multiplan Commercial |
$287.10
|
| Rate for Payer: Networks By Design Commercial |
$248.82
|
| Rate for Payer: Prime Health Services Commercial |
$325.38
|
| Rate for Payer: Riverside University Health System MISP |
$153.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.40
|
| Rate for Payer: United Healthcare All Other HMO |
$191.40
|
| Rate for Payer: United Healthcare HMO Rider |
$191.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$325.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.38
|
|
|
HC WOUND CROWN- FISTULA MGMT
|
Facility
|
IP
|
$382.80
|
|
| Hospital Charge Code |
901608082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.52 |
| Rate for Payer: Adventist Health Commercial |
$76.56
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$267.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Senior |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.38
|
| Rate for Payer: Global Benefits Group Commercial |
$229.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$225.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.10
|
| Rate for Payer: Networks By Design Commercial |
$248.82
|
| Rate for Payer: Prime Health Services Commercial |
$325.38
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
|
IP
|
$12,633.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,526.60 |
| Max. Negotiated Rate |
$11,369.70 |
| Rate for Payer: Adventist Health Commercial |
$2,526.60
|
| Rate for Payer: Cash Price |
$5,684.85
|
| Rate for Payer: Central Health Plan Commercial |
$10,106.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,843.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,053.20
|
| Rate for Payer: Galaxy Health WC |
$10,738.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,579.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,369.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,021.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,453.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,526.60
|
| Rate for Payer: Multiplan Commercial |
$9,474.75
|
| Rate for Payer: Networks By Design Commercial |
$8,211.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,738.05
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
|
OP
|
$12,633.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$11,369.70 |
| Rate for Payer: Adventist Health Commercial |
$5,179.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,390.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$5,684.85
|
| Rate for Payer: Cash Price |
$5,684.85
|
| Rate for Payer: Cash Price |
$5,684.85
|
| Rate for Payer: Cash Price |
$5,684.85
|
| Rate for Payer: Central Health Plan Commercial |
$10,106.40
|
| Rate for Payer: Cigna of CA HMO |
$8,085.12
|
| Rate for Payer: Cigna of CA PPO |
$9,348.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,843.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$10,738.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,579.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,369.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,021.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,526.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$9,474.75
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$8,211.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$10,738.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,579.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,579.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
|
IP
|
$12,633.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,526.60 |
| Max. Negotiated Rate |
$11,369.70 |
| Rate for Payer: Adventist Health Commercial |
$2,526.60
|
| Rate for Payer: Cash Price |
$5,684.85
|
| Rate for Payer: Central Health Plan Commercial |
$10,106.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,843.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,053.20
|
| Rate for Payer: Galaxy Health WC |
$10,738.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,579.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,369.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,021.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,453.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,526.60
|
| Rate for Payer: Multiplan Commercial |
$9,474.75
|
| Rate for Payer: Networks By Design Commercial |
$8,211.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,738.05
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
|
OP
|
$12,633.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$11,369.70 |
| Rate for Payer: Adventist Health Commercial |
$2,526.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,703.23
|
| Rate for Payer: Cash Price |
$5,684.85
|
| Rate for Payer: Cash Price |
$5,684.85
|
| Rate for Payer: Cash Price |
$5,684.85
|
| Rate for Payer: Cash Price |
$5,684.85
|
| Rate for Payer: Central Health Plan Commercial |
$10,106.40
|
| Rate for Payer: Cigna of CA HMO |
$8,085.12
|
| Rate for Payer: Cigna of CA PPO |
$9,348.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,843.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$10,738.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,579.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,369.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,021.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,852.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,526.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$9,474.75
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$8,211.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Preferred Health Network WC |
$3,778.81
|
| Rate for Payer: Prime Health Services Commercial |
$10,738.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,812.94
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,919.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,579.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,316.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,316.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,316.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,316.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC WOUND EXPLORATION TRAUMA EXTRE
|
Facility
|
IP
|
$10,808.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
900501282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,161.60 |
| Max. Negotiated Rate |
$9,727.20 |
| Rate for Payer: Adventist Health Commercial |
$2,161.60
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,646.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,565.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,323.20
|
| Rate for Payer: Galaxy Health WC |
$9,186.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,727.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,863.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,376.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,161.60
|
| Rate for Payer: Multiplan Commercial |
$8,106.00
|
| Rate for Payer: Networks By Design Commercial |
$7,025.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,186.80
|
|
|
HC WOUND EXPLORATION TRAUMA EXTRE
|
Facility
|
OP
|
$10,808.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
900501282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.61 |
| Max. Negotiated Rate |
$9,727.20 |
| Rate for Payer: Adventist Health Commercial |
$2,161.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Cash Price |
$4,863.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,646.40
|
| Rate for Payer: Cigna of CA HMO |
$6,917.12
|
| Rate for Payer: Cigna of CA PPO |
$7,997.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,565.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| Rate for Payer: Galaxy Health WC |
$9,186.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,727.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,863.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,161.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$8,106.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$7,025.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$9,186.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,251.68
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,336.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,404.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,404.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,404.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,404.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC WOUND MATRIX NEOX 100 2.0X2.0
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$610.20 |
| Rate for Payer: Adventist Health Commercial |
$135.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$294.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$367.37
|
| Rate for Payer: Blue Shield of California Commercial |
$429.85
|
| Rate for Payer: Blue Shield of California EPN |
$270.52
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Central Health Plan Commercial |
$542.40
|
| Rate for Payer: Cigna of CA HMO |
$474.60
|
| Rate for Payer: Cigna of CA PPO |
$474.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$474.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$576.30
|
| Rate for Payer: Global Benefits Group Commercial |
$406.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$610.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$430.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$508.50
|
| Rate for Payer: Networks By Design Commercial |
$339.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$576.30
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$406.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$406.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.45
|
| Rate for Payer: United Healthcare All Other HMO |
$247.67
|
| Rate for Payer: United Healthcare HMO Rider |
$242.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC WOUND MATRIX NEOX 100 2.0X2.0
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$610.20 |
| Rate for Payer: Adventist Health Commercial |
$135.60
|
| Rate for Payer: Blue Shield of California Commercial |
$543.76
|
| Rate for Payer: Blue Shield of California EPN |
$341.71
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Central Health Plan Commercial |
$542.40
|
| Rate for Payer: Cigna of CA HMO |
$474.60
|
| Rate for Payer: Cigna of CA PPO |
$474.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$474.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Senior |
$271.20
|
| Rate for Payer: Galaxy Health WC |
$576.30
|
| Rate for Payer: Global Benefits Group Commercial |
$406.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$610.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$430.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$400.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$508.50
|
| Rate for Payer: Networks By Design Commercial |
$339.00
|
| Rate for Payer: Prime Health Services Commercial |
$576.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$254.45
|
| Rate for Payer: United Healthcare All Other HMO |
$247.67
|
| Rate for Payer: United Healthcare HMO Rider |
$242.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.04
|
|
|
HC WOUND MATRIX NEOX 100 3.0X3.0
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$401.27 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$294.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$367.37
|
| Rate for Payer: Blue Shield of California Commercial |
$273.25
|
| Rate for Payer: Blue Shield of California EPN |
$171.97
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: Cigna of CA HMO |
$301.70
|
| Rate for Payer: Cigna of CA PPO |
$301.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$215.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.75
|
| Rate for Payer: United Healthcare All Other HMO |
$157.44
|
| Rate for Payer: United Healthcare HMO Rider |
$154.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC WOUND MATRIX NEOX 100 3.0X3.0
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Adventist Health Commercial |
$86.20
|
| Rate for Payer: Blue Shield of California Commercial |
$345.66
|
| Rate for Payer: Blue Shield of California EPN |
$217.22
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: Cigna of CA HMO |
$301.70
|
| Rate for Payer: Cigna of CA PPO |
$301.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: EPIC Health Plan Senior |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$254.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$215.50
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.75
|
| Rate for Payer: United Healthcare All Other HMO |
$157.44
|
| Rate for Payer: United Healthcare HMO Rider |
$154.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.15
|
|
|
HC WOUND MATRIX NEOX 100 4.0X4.0
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Blue Shield of California Commercial |
$195.69
|
| Rate for Payer: Blue Shield of California EPN |
$122.98
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$122.00
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.57
|
| Rate for Payer: United Healthcare All Other HMO |
$89.13
|
| Rate for Payer: United Healthcare HMO Rider |
$87.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.91
|
|
|
HC WOUND MATRIX NEOX 100 4.0X4.0
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$401.27 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$294.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$367.37
|
| Rate for Payer: Blue Shield of California Commercial |
$154.70
|
| Rate for Payer: Blue Shield of California EPN |
$97.36
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$122.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.57
|
| Rate for Payer: United Healthcare All Other HMO |
$89.13
|
| Rate for Payer: United Healthcare HMO Rider |
$87.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC WOUND MATRIX NEOX 100 7.0X7.0
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Blue Shield of California Commercial |
$118.70
|
| Rate for Payer: Blue Shield of California EPN |
$74.59
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Cigna of CA HMO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$74.00
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
|
|
HC WOUND MATRIX NEOX 100 7.0X7.0
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$401.27 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$294.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$367.37
|
| Rate for Payer: Blue Shield of California Commercial |
$93.83
|
| Rate for Payer: Blue Shield of California EPN |
$59.05
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Cigna of CA HMO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$74.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC WOUND MATRIX NEOX FLO 100MG PARTICULATE
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$31.28
|
| Rate for Payer: Blue Shield of California EPN |
$19.66
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$27.30
|
| Rate for Payer: Cigna of CA PPO |
$27.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.64
|
| Rate for Payer: United Healthcare All Other HMO |
$14.25
|
| Rate for Payer: United Healthcare HMO Rider |
$13.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.77
|
|
|
HC WOUND MATRIX NEOX FLO 100MG PARTICULATE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$163.03 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.69
|
| Rate for Payer: Blue Shield of California Commercial |
$24.73
|
| Rate for Payer: Blue Shield of California EPN |
$15.56
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$27.30
|
| Rate for Payer: Cigna of CA PPO |
$27.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Riverside University Health System MISP |
$15.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.64
|
| Rate for Payer: United Healthcare All Other HMO |
$14.25
|
| Rate for Payer: United Healthcare HMO Rider |
$13.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC WOUND MATRIX NEOX FLO 150MG PARTICULATE
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$163.03 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.29
|
| Rate for Payer: Blue Shield of California Commercial |
$17.75
|
| Rate for Payer: Blue Shield of California EPN |
$11.17
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$19.60
|
| Rate for Payer: Cigna of CA PPO |
$19.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$14.00
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Riverside University Health System MISP |
$11.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.51
|
| Rate for Payer: United Healthcare All Other HMO |
$10.23
|
| Rate for Payer: United Healthcare HMO Rider |
$10.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.80
|
| Rate for Payer: Vantage Medical Group Senior |
$23.80
|
|
|
HC WOUND MATRIX NEOX FLO 150MG PARTICULATE
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.46
|
| Rate for Payer: Blue Shield of California EPN |
$14.11
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$19.60
|
| Rate for Payer: Cigna of CA PPO |
$19.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$14.00
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.51
|
| Rate for Payer: United Healthcare All Other HMO |
$10.23
|
| Rate for Payer: United Healthcare HMO Rider |
$10.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.17
|
|
|
HC WOUND MATRIX NEOX FLO 25MG PARTICULATE
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Blue Shield of California Commercial |
$59.35
|
| Rate for Payer: Blue Shield of California EPN |
$37.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Central Health Plan Commercial |
$59.20
|
| Rate for Payer: Cigna of CA HMO |
$51.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.60
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: Networks By Design Commercial |
$37.00
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.77
|
| Rate for Payer: United Healthcare All Other HMO |
$27.03
|
| Rate for Payer: United Healthcare HMO Rider |
$26.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.23
|
|
