|
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: 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 Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.61
|
| 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 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 |
$153.65
|
| 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 |
$7.93
|
| Rate for Payer: Blue Shield of California Commercial |
$153.57
|
| 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: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.39
|
| 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: InnovAge PACE Commercial |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.22
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$702.66
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$562.67
|
| 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 2.0X1.0
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$552.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$681.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$440.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$533.86
|
| Rate for Payer: Blue Shield of California Commercial |
$555.40
|
| 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 |
$772.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$772.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$772.65
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$128.43
|
| Rate for Payer: InnovAge PACE Commercial |
$454.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$562.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$636.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$636.30
|
| 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: Riverside University Health System MISP |
$363.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$772.65
|
| Rate for Payer: Vantage Medical Group Senior |
$772.65
|
|
|
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 |
$749.81
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$646.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$600.43
|
| 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 |
$128.43 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: Adventist Health Commercial |
$194.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$589.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$824.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$533.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$727.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$469.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$569.68
|
| Rate for Payer: Blue Shield of California Commercial |
$592.67
|
| 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 |
$824.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$824.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$824.50
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$128.43
|
| Rate for Payer: InnovAge PACE Commercial |
$485.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$646.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$600.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.00
|
| 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: Riverside University Health System MISP |
$388.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$824.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$824.50
|
| Rate for Payer: Vantage Medical Group Senior |
$824.50
|
|
|
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 |
$128.43 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Adventist Health Commercial |
$130.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$394.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$552.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$487.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$314.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.75
|
| Rate for Payer: Blue Shield of California Commercial |
$397.15
|
| 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 |
$552.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$552.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$552.50
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$128.43
|
| Rate for Payer: InnovAge PACE Commercial |
$325.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$455.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$455.00
|
| 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: Riverside University Health System MISP |
$260.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$552.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$552.50
|
| Rate for Payer: Vantage Medical Group Senior |
$552.50
|
|
|
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 |
$502.45
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.35
|
| 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 |
$364.08
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$314.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$291.55
|
| 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 |
$423.90 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$286.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$400.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$259.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$228.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$276.62
|
| Rate for Payer: Blue Shield of California Commercial |
$287.78
|
| 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 |
$400.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$400.35
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$128.43
|
| Rate for Payer: InnovAge PACE Commercial |
$235.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$291.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$329.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$329.70
|
| 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: Riverside University Health System MISP |
$188.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$400.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.35
|
| Rate for Payer: Vantage Medical Group Senior |
$400.35
|
|
|
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 |
$411.30 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$277.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$388.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$342.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.40
|
| Rate for Payer: Blue Shield of California Commercial |
$279.23
|
| 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 |
$388.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$388.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$388.45
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$128.43
|
| Rate for Payer: InnovAge PACE Commercial |
$228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$319.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$319.90
|
| 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: Riverside University Health System MISP |
$182.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$388.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$388.45
|
| Rate for Payer: Vantage Medical Group Senior |
$388.45
|
|
|
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 |
$353.26
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$304.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.88
|
| 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
|
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 |
$702.66
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$562.67
|
| 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 2.0X1.0CM
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$552.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$681.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$440.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$533.86
|
| Rate for Payer: Blue Shield of California Commercial |
$555.40
|
| 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 |
$772.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$772.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$772.65
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$128.43
|
| Rate for Payer: InnovAge PACE Commercial |
$454.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$562.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$636.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$636.30
|
| 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: Riverside University Health System MISP |
$363.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$772.65
|
| Rate for Payer: Vantage Medical Group Senior |
$772.65
|
|
|
HC CORD NEOX RT 2.0X2.0CM
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$697.50 |
| Rate for Payer: Adventist Health Commercial |
$155.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$658.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$581.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$375.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$455.16
|
| Rate for Payer: Blue Shield of California Commercial |
$473.52
|
| Rate for Payer: Blue Shield of California EPN |
$309.23
|
| Rate for Payer: Cash Price |
$348.75
|
| 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: Dignity Health Commercial/Exchange |
$658.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$658.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$658.75
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$128.43
|
| Rate for Payer: InnovAge PACE Commercial |
$387.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$542.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$542.50
|
| 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: Riverside University Health System MISP |
$310.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$465.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$465.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$658.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$658.75
|
| Rate for Payer: Vantage Medical Group Senior |
$658.75
|
|
|
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 |
$599.08
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$516.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$479.73
|
| 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
|
|
|
HC CORD NEOX RT 3.0X2.0CM
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102202
|
|
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 |
$502.45
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.35
|
| 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 NEOX RT 3.0X2.0CM
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Adventist Health Commercial |
$130.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$394.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$552.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$487.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$314.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.75
|
| Rate for Payer: Blue Shield of California Commercial |
$397.15
|
| 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 |
$552.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$552.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$552.50
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$128.43
|
| Rate for Payer: InnovAge PACE Commercial |
$325.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$455.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$455.00
|
| 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: Riverside University Health System MISP |
$260.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$552.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$552.50
|
| Rate for Payer: Vantage Medical Group Senior |
$552.50
|
|
|
HC CORD NEOX RT 3.0X3.0CM
|
Facility
|
IP
|
$433.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.60 |
| Max. Negotiated Rate |
$389.70 |
| Rate for Payer: Adventist Health Commercial |
$86.60
|
| Rate for Payer: Blue Shield of California Commercial |
$334.71
|
| Rate for Payer: Blue Shield of California EPN |
$218.23
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Central Health Plan Commercial |
$346.40
|
| Rate for Payer: Cigna of CA HMO |
$303.10
|
| Rate for Payer: Cigna of CA PPO |
$303.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$173.20
|
| Rate for Payer: Galaxy Health WC |
$368.05
|
| Rate for Payer: Global Benefits Group Commercial |
$259.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$389.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$268.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.60
|
| Rate for Payer: Multiplan Commercial |
$324.75
|
| Rate for Payer: Networks By Design Commercial |
$216.50
|
| Rate for Payer: Prime Health Services Commercial |
$368.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.50
|
| Rate for Payer: United Healthcare All Other HMO |
$158.17
|
| Rate for Payer: United Healthcare HMO Rider |
$154.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.81
|
|
|
HC CORD NEOX RT 3.0X3.0CM
|
Facility
|
OP
|
$433.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.60 |
| Max. Negotiated Rate |
$389.70 |
| Rate for Payer: Adventist Health Commercial |
$86.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$262.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$368.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$209.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.30
|
| Rate for Payer: Blue Shield of California Commercial |
$264.56
|
| Rate for Payer: Blue Shield of California EPN |
$172.77
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Cash Price |
$194.85
|
| Rate for Payer: Central Health Plan Commercial |
$346.40
|
| Rate for Payer: Cigna of CA HMO |
$303.10
|
| Rate for Payer: Cigna of CA PPO |
$303.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$368.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$368.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$173.20
|
| Rate for Payer: Galaxy Health WC |
$368.05
|
| Rate for Payer: Global Benefits Group Commercial |
$259.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$389.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.43
|
| Rate for Payer: InnovAge PACE Commercial |
$216.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$268.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.10
|
| Rate for Payer: Multiplan Commercial |
$324.75
|
| Rate for Payer: Networks By Design Commercial |
$216.50
|
| Rate for Payer: Prime Health Services Commercial |
$368.05
|
| Rate for Payer: Riverside University Health System MISP |
$173.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$259.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$259.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.50
|
| Rate for Payer: United Healthcare All Other HMO |
$158.17
|
| Rate for Payer: United Healthcare HMO Rider |
$154.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$368.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.05
|
| Rate for Payer: Vantage Medical Group Senior |
$368.05
|
|
|
HC CORD NEOX RT 4.0X3.0CM
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Blue Shield of California Commercial |
$251.22
|
| Rate for Payer: Blue Shield of California EPN |
$163.80
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$227.50
|
| Rate for Payer: Cigna of CA PPO |
$227.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.97
|
| Rate for Payer: United Healthcare All Other HMO |
$118.72
|
| Rate for Payer: United Healthcare HMO Rider |
$116.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.44
|
|
|
HC CORD NEOX RT 4.0X3.0CM
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Adventist Health Commercial |
$65.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.87
|
| Rate for Payer: Blue Shield of California Commercial |
$198.57
|
| Rate for Payer: Blue Shield of California EPN |
$129.68
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: Cigna of CA HMO |
$227.50
|
| Rate for Payer: Cigna of CA PPO |
$227.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$276.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Senior |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.43
|
| Rate for Payer: InnovAge PACE Commercial |
$162.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.50
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
| Rate for Payer: Riverside University Health System MISP |
$130.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.97
|
| Rate for Payer: United Healthcare All Other HMO |
$118.72
|
| Rate for Payer: United Healthcare HMO Rider |
$116.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$276.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.25
|
| Rate for Payer: Vantage Medical Group Senior |
$276.25
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$386.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$759.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$763.75
|
| Rate for Payer: Blue Shield of California EPN |
$498.75
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.00
|
| Rate for Payer: Cigna of CA HMO |
$800.00
|
| Rate for Payer: Cigna of CA PPO |
$925.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$579.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$386.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$521.77
|
| Rate for Payer: EPIC Health Plan Senior |
$386.50
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$633.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$294.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$386.50
|
| Rate for Payer: InnovAge PACE Commercial |
$579.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$386.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$517.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$517.91
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$386.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
| Rate for Payer: Prime Health Services Medicare |
$409.69
|
| Rate for Payer: Riverside University Health System MISP |
$425.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$386.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$579.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.15
|
| Rate for Payer: Vantage Medical Group Senior |
$386.50
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.00
|
| Rate for Payer: EPIC Health Plan Senior |
$500.00
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$773.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.00
|
| Rate for Payer: Multiplan Commercial |
$937.50
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
|
|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
|
IP
|
$6,946.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,389.20 |
| Max. Negotiated Rate |
$6,251.40 |
| Rate for Payer: Adventist Health Commercial |
$1,389.20
|
| Rate for Payer: Cash Price |
$3,125.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,778.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,778.40
|
| Rate for Payer: Galaxy Health WC |
$5,904.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,167.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,251.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,632.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,646.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,299.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,389.20
|
| Rate for Payer: Multiplan Commercial |
$5,209.50
|
| Rate for Payer: Networks By Design Commercial |
$4,514.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,904.10
|
|
