|
HC CONVERT INSTEP TO VELCRO CLOSU
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT L3580
|
| Hospital Charge Code |
905353580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Blue Shield of California Commercial |
$104.26
|
| Rate for Payer: Blue Shield of California EPN |
$65.52
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: Cigna of CA HMO |
$91.00
|
| Rate for Payer: Cigna of CA PPO |
$91.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.79
|
| Rate for Payer: United Healthcare All Other HMO |
$47.49
|
| Rate for Payer: United Healthcare HMO Rider |
$46.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.58
|
|
|
HC CONVERT INSTEP TO VELCRO CLOSU
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT L3580
|
| Hospital Charge Code |
915353580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.25 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$53.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.62
|
| Rate for Payer: Blue Shield of California Commercial |
$104.26
|
| Rate for Payer: Blue Shield of California EPN |
$65.52
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: Cigna of CA HMO |
$91.00
|
| Rate for Payer: Cigna of CA PPO |
$91.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Riverside University Health System MISP |
$52.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.79
|
| Rate for Payer: United Healthcare All Other HMO |
$47.49
|
| Rate for Payer: United Healthcare HMO Rider |
$46.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.50
|
| Rate for Payer: Vantage Medical Group Senior |
$110.50
|
|
|
HC COOMBS TEST DIRECT
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.34
|
| Rate for Payer: Blue Shield of California Commercial |
$159.39
|
| Rate for Payer: Blue Shield of California EPN |
$100.44
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Cigna of CA HMO |
$161.92
|
| Rate for Payer: Cigna of CA PPO |
$187.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.89
|
| Rate for Payer: EPIC Health Plan Senior |
$5.93
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.39
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Prime Health Services Medicare |
$5.71
|
| Rate for Payer: Riverside University Health System MISP |
$5.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC COOMBS TEST DIRECT
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Central Health Plan Commercial |
$202.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$177.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$227.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$149.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$189.75
|
| Rate for Payer: Networks By Design Commercial |
$164.45
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
|
|
HC COR A 14 (HAZELNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7.40
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
|
|
HC COR A 14 (HAZELNUT), IGE
|
Facility
|
OP
|
$15.41
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$167.30 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.65
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.12
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Central Health Plan Commercial |
$12.33
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Cigna of CA HMO |
$11.83
|
| Rate for Payer: Cigna of CA HMO |
$9.86
|
| Rate for Payer: Cigna of CA PPO |
$13.68
|
| Rate for Payer: Cigna of CA PPO |
$11.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Galaxy Health WC |
$13.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
| Rate for Payer: Prime Health Services Commercial |
$13.10
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC COR A 1 (HAZELNUT), IGE
|
Facility
|
OP
|
$15.41
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913735
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$167.30 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.65
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.12
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Central Health Plan Commercial |
$12.33
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Cigna of CA HMO |
$11.83
|
| Rate for Payer: Cigna of CA HMO |
$9.86
|
| Rate for Payer: Cigna of CA PPO |
$13.68
|
| Rate for Payer: Cigna of CA PPO |
$11.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Galaxy Health WC |
$13.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
| Rate for Payer: Prime Health Services Commercial |
$13.10
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC COR A 1 (HAZELNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913735
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7.40
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
|
|
HC COR A 8 (HAZELNUT), IGE
|
Facility
|
OP
|
$15.41
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$167.30 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.65
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.12
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Central Health Plan Commercial |
$12.33
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Cigna of CA HMO |
$11.83
|
| Rate for Payer: Cigna of CA HMO |
$9.86
|
| Rate for Payer: Cigna of CA PPO |
$13.68
|
| Rate for Payer: Cigna of CA PPO |
$11.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Galaxy Health WC |
$13.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
| Rate for Payer: Prime Health Services Commercial |
$13.10
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC COR A 8 (HAZELNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7.40
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
|
|
HC COR A 9 (HAZELNUT), IGE
|
Facility
|
OP
|
$15.41
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$167.30 |
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.65
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.34
|
| Rate for Payer: Blue Shield of California EPN |
$6.12
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Central Health Plan Commercial |
$12.33
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Cigna of CA HMO |
$11.83
|
| Rate for Payer: Cigna of CA HMO |
$9.86
|
| Rate for Payer: Cigna of CA PPO |
$13.68
|
| Rate for Payer: Cigna of CA PPO |
$11.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Galaxy Health WC |
$13.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Global Benefits Group Commercial |
$9.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Networks By Design Commercial |
$10.02
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
| Rate for Payer: Prime Health Services Commercial |
$13.10
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC COR A 9 (HAZELNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Central Health Plan Commercial |
$14.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7.40
|
| Rate for Payer: Galaxy Health WC |
$15.72
|
| Rate for Payer: Global Benefits Group Commercial |
$11.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.70
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: Networks By Design Commercial |
$12.02
|
| Rate for Payer: Prime Health Services Commercial |
$15.72
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 2.0X1.0
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$795.92
|
| 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 |
$440.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.77
|
| Rate for Payer: Blue Shield of California Commercial |
$576.31
|
| Rate for Payer: Blue Shield of California EPN |
$362.69
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Central Health Plan Commercial |
$727.20
|
| Rate for Payer: Cigna of CA HMO |
$636.30
|
| Rate for Payer: Cigna of CA PPO |
$636.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$636.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$818.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$577.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$329.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$681.75
|
| Rate for Payer: Networks By Design Commercial |
$454.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| 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 |
$545.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$545.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.15
|
| Rate for Payer: United Healthcare All Other HMO |
$332.06
|
| Rate for Payer: United Healthcare HMO Rider |
$324.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.70
|
| 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 CORD HC WOUND MATRIX NEOX 1K 2.0X1.0
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.80 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Blue Shield of California Commercial |
$729.02
|
| Rate for Payer: Blue Shield of California EPN |
$458.14
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Central Health Plan Commercial |
$727.20
|
| Rate for Payer: Cigna of CA HMO |
$636.30
|
| Rate for Payer: Cigna of CA PPO |
$636.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$636.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Senior |
$363.60
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$818.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$577.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$536.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.80
|
| Rate for Payer: Multiplan Commercial |
$681.75
|
| Rate for Payer: Networks By Design Commercial |
$454.50
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.15
|
| Rate for Payer: United Healthcare All Other HMO |
$332.06
|
| Rate for Payer: United Healthcare HMO Rider |
$324.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.70
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 2.0X2.0
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: Adventist Health Commercial |
$194.00
|
| Rate for Payer: Blue Shield of California Commercial |
$777.94
|
| Rate for Payer: Blue Shield of California EPN |
$488.88
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Central Health Plan Commercial |
$776.00
|
| Rate for Payer: Cigna of CA HMO |
$679.00
|
| Rate for Payer: Cigna of CA PPO |
$679.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.00
|
| Rate for Payer: EPIC Health Plan Senior |
$388.00
|
| Rate for Payer: Galaxy Health WC |
$824.50
|
| Rate for Payer: Global Benefits Group Commercial |
$582.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$615.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$572.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Multiplan Commercial |
$727.50
|
| Rate for Payer: Networks By Design Commercial |
$485.00
|
| Rate for Payer: Prime Health Services Commercial |
$824.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.04
|
| Rate for Payer: United Healthcare All Other HMO |
$354.34
|
| Rate for Payer: United Healthcare HMO Rider |
$346.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$317.68
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 2.0X2.0
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: Adventist Health Commercial |
$194.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$795.92
|
| 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 |
$469.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$564.25
|
| Rate for Payer: Blue Shield of California Commercial |
$614.98
|
| Rate for Payer: Blue Shield of California EPN |
$387.03
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Central Health Plan Commercial |
$776.00
|
| Rate for Payer: Cigna of CA HMO |
$679.00
|
| Rate for Payer: Cigna of CA PPO |
$679.00
|
| 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 |
$679.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$824.50
|
| Rate for Payer: Global Benefits Group Commercial |
$582.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$873.00
|
| 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 |
$615.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$727.50
|
| Rate for Payer: Networks By Design Commercial |
$485.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$824.50
|
| 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 |
$582.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$582.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.04
|
| Rate for Payer: United Healthcare All Other HMO |
$354.34
|
| Rate for Payer: United Healthcare HMO Rider |
$346.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$317.68
|
| 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 CORD HC WOUND MATRIX NEOX 1K 3.0X2.0
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$795.92 |
| Rate for Payer: Adventist Health Commercial |
$130.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$795.92
|
| 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 |
$314.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$378.11
|
| Rate for Payer: Blue Shield of California Commercial |
$412.10
|
| Rate for Payer: Blue Shield of California EPN |
$259.35
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Central Health Plan Commercial |
$520.00
|
| Rate for Payer: Cigna of CA HMO |
$455.00
|
| Rate for Payer: Cigna of CA PPO |
$455.00
|
| 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 |
$455.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$552.50
|
| Rate for Payer: Global Benefits Group Commercial |
$390.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.00
|
| 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 |
$412.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$487.50
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$552.50
|
| 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 |
$390.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$390.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.94
|
| Rate for Payer: United Healthcare All Other HMO |
$237.44
|
| Rate for Payer: United Healthcare HMO Rider |
$232.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$212.88
|
| 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 CORD HC WOUND MATRIX NEOX 1K 3.0X2.0
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Adventist Health Commercial |
$130.00
|
| Rate for Payer: Blue Shield of California Commercial |
$521.30
|
| Rate for Payer: Blue Shield of California EPN |
$327.60
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Central Health Plan Commercial |
$520.00
|
| Rate for Payer: Cigna of CA HMO |
$455.00
|
| Rate for Payer: Cigna of CA PPO |
$455.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$455.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$260.00
|
| Rate for Payer: Galaxy Health WC |
$552.50
|
| Rate for Payer: Global Benefits Group Commercial |
$390.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$412.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Multiplan Commercial |
$487.50
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$552.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.94
|
| Rate for Payer: United Healthcare All Other HMO |
$237.44
|
| Rate for Payer: United Healthcare HMO Rider |
$232.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$212.88
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 3.0X3.0
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$423.90 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Blue Shield of California Commercial |
$377.74
|
| Rate for Payer: Blue Shield of California EPN |
$237.38
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Central Health Plan Commercial |
$376.80
|
| Rate for Payer: Cigna of CA HMO |
$329.70
|
| Rate for Payer: Cigna of CA PPO |
$329.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: EPIC Health Plan Senior |
$188.40
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$299.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.20
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
| Rate for Payer: Networks By Design Commercial |
$235.50
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.77
|
| Rate for Payer: United Healthcare All Other HMO |
$172.06
|
| Rate for Payer: United Healthcare HMO Rider |
$168.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.25
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 3.0X3.0
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$795.92 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$795.92
|
| 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 |
$228.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$273.98
|
| Rate for Payer: Blue Shield of California Commercial |
$298.61
|
| Rate for Payer: Blue Shield of California EPN |
$187.93
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Central Health Plan Commercial |
$376.80
|
| Rate for Payer: Cigna of CA HMO |
$329.70
|
| Rate for Payer: Cigna of CA PPO |
$329.70
|
| 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 |
$329.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$400.35
|
| Rate for Payer: Global Benefits Group Commercial |
$282.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.90
|
| 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 |
$299.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
| Rate for Payer: Networks By Design Commercial |
$235.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$400.35
|
| 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 |
$282.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.77
|
| Rate for Payer: United Healthcare All Other HMO |
$172.06
|
| Rate for Payer: United Healthcare HMO Rider |
$168.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$154.25
|
| 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 CORD HC WOUND MATRIX NEOX 1K 4.0X3.0
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$795.92 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$795.92
|
| 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 |
$221.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.84
|
| Rate for Payer: Blue Shield of California Commercial |
$289.74
|
| Rate for Payer: Blue Shield of California EPN |
$182.34
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Central Health Plan Commercial |
$365.60
|
| Rate for Payer: Cigna of CA HMO |
$319.90
|
| Rate for Payer: Cigna of CA PPO |
$319.90
|
| 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 |
$319.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$411.30
|
| 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 |
$290.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$342.75
|
| Rate for Payer: Networks By Design Commercial |
$228.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
| 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 |
$274.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.51
|
| Rate for Payer: United Healthcare All Other HMO |
$166.94
|
| Rate for Payer: United Healthcare HMO Rider |
$163.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.67
|
| 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 CORD HC WOUND MATRIX NEOX 1K 4.0X3.0
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$411.30 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Blue Shield of California Commercial |
$366.51
|
| Rate for Payer: Blue Shield of California EPN |
$230.33
|
| Rate for Payer: Cash Price |
$205.65
|
| Rate for Payer: Central Health Plan Commercial |
$365.60
|
| Rate for Payer: Cigna of CA HMO |
$319.90
|
| Rate for Payer: Cigna of CA PPO |
$319.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.80
|
| Rate for Payer: EPIC Health Plan Senior |
$182.80
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$411.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.40
|
| Rate for Payer: Multiplan Commercial |
$342.75
|
| Rate for Payer: Networks By Design Commercial |
$228.50
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.51
|
| Rate for Payer: United Healthcare All Other HMO |
$166.94
|
| Rate for Payer: United Healthcare HMO Rider |
$163.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.67
|
|
|
HC CORD NEOX RT 2.0X1.0CM
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$795.92
|
| 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 |
$440.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.77
|
| Rate for Payer: Blue Shield of California Commercial |
$576.31
|
| Rate for Payer: Blue Shield of California EPN |
$362.69
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Central Health Plan Commercial |
$727.20
|
| Rate for Payer: Cigna of CA HMO |
$636.30
|
| Rate for Payer: Cigna of CA PPO |
$636.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$636.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$818.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$577.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$329.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$681.75
|
| Rate for Payer: Networks By Design Commercial |
$454.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| 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 |
$545.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$545.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.15
|
| Rate for Payer: United Healthcare All Other HMO |
$332.06
|
| Rate for Payer: United Healthcare HMO Rider |
$324.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.70
|
| 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 CORD NEOX RT 2.0X1.0CM
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.80 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Blue Shield of California Commercial |
$729.02
|
| Rate for Payer: Blue Shield of California EPN |
$458.14
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Central Health Plan Commercial |
$727.20
|
| Rate for Payer: Cigna of CA HMO |
$636.30
|
| Rate for Payer: Cigna of CA PPO |
$636.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$636.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Senior |
$363.60
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$818.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$577.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$536.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.80
|
| Rate for Payer: Multiplan Commercial |
$681.75
|
| Rate for Payer: Networks By Design Commercial |
$454.50
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.15
|
| Rate for Payer: United Healthcare All Other HMO |
$332.06
|
| Rate for Payer: United Healthcare HMO Rider |
$324.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.70
|
|
|
HC CORD NEOX RT 2.0X2.0CM
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$697.50 |
| Rate for Payer: Adventist Health Commercial |
$155.00
|
| Rate for Payer: Blue Shield of California Commercial |
$621.55
|
| Rate for Payer: Blue Shield of California EPN |
$390.60
|
| Rate for Payer: Cash Price |
$348.75
|
| Rate for Payer: Central Health Plan Commercial |
$620.00
|
| Rate for Payer: Cigna of CA HMO |
$542.50
|
| Rate for Payer: Cigna of CA PPO |
$542.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.00
|
| Rate for Payer: EPIC Health Plan Senior |
$310.00
|
| Rate for Payer: Galaxy Health WC |
$658.75
|
| Rate for Payer: Global Benefits Group Commercial |
$465.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$697.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$492.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$457.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$581.25
|
| Rate for Payer: Networks By Design Commercial |
$387.50
|
| Rate for Payer: Prime Health Services Commercial |
$658.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.86
|
| Rate for Payer: United Healthcare All Other HMO |
$283.11
|
| Rate for Payer: United Healthcare HMO Rider |
$276.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.81
|
|
