|
HC CONTRAST BATHS 15 MIN MCAL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
901300051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.65 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$118.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$76.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$83.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Central Health Plan Commercial |
$111.20
|
| Rate for Payer: Cigna of CA HMO |
$88.96
|
| Rate for Payer: Cigna of CA PPO |
$102.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$104.25
|
| Rate for Payer: IEHP medi-cal |
$48.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.99
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: Riverside University Health MISP |
$55.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$118.15
|
| Rate for Payer: Vantage Medical Group Senior |
$118.15
|
|
|
HC CONTRAST BATHS 15 MIN MCARE COMM
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900407034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.65 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$118.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$76.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$83.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Central Health Plan Commercial |
$111.20
|
| Rate for Payer: Cigna of CA HMO |
$88.96
|
| Rate for Payer: Cigna of CA PPO |
$102.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$104.25
|
| Rate for Payer: IEHP medi-cal |
$48.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.99
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: Riverside University Health MISP |
$55.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$118.15
|
| Rate for Payer: Vantage Medical Group Senior |
$118.15
|
|
|
HC CONTRAST BATHS 15 MIN MCARE COMM
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900407034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Central Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.80
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905103124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.65 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$118.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$76.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$83.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Central Health Plan Commercial |
$111.20
|
| Rate for Payer: Cigna of CA HMO |
$88.96
|
| Rate for Payer: Cigna of CA PPO |
$102.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$104.25
|
| Rate for Payer: IEHP medi-cal |
$48.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.99
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: Riverside University Health MISP |
$55.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$118.15
|
| Rate for Payer: Vantage Medical Group Senior |
$118.15
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
905103124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Central Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.80
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900417034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.65 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$118.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$76.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$83.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Central Health Plan Commercial |
$111.20
|
| Rate for Payer: Cigna of CA HMO |
$88.96
|
| Rate for Payer: Cigna of CA PPO |
$102.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$104.25
|
| Rate for Payer: IEHP medi-cal |
$48.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.99
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: Riverside University Health MISP |
$55.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$83.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$83.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$118.15
|
| Rate for Payer: Vantage Medical Group Senior |
$118.15
|
|
|
HC CONTRAST BATHS 15 MIN PT
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 97034
|
| Hospital Charge Code |
900417034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: Central Health Plan Commercial |
$111.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.60
|
| Rate for Payer: Galaxy Health WC |
$118.15
|
| Rate for Payer: Global Benefits Group Commercial |
$83.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$125.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.80
|
| Rate for Payer: Multiplan Commercial |
$104.25
|
| Rate for Payer: Networks By Design Commercial |
$90.35
|
| Rate for Payer: Prime Health Services Commercial |
$118.15
|
|
|
HC CONTRAST BATHS 30 MIN OT
|
Facility
OP
|
$228.00
|
|
|
Service Code
|
CPT 97126
|
| Hospital Charge Code |
905104195
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$138.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$125.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$136.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Central Health Plan Commercial |
$182.40
|
| Rate for Payer: Cigna of CA HMO |
$145.92
|
| Rate for Payer: Cigna of CA PPO |
$168.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$171.00
|
| Rate for Payer: IEHP medi-cal |
$79.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.48
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$136.80
|
| Rate for Payer: Riverside University Health MISP |
$91.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC CONTRAST BATHS 30 MIN OT
|
Facility
IP
|
$228.00
|
|
|
Service Code
|
CPT 97126
|
| Hospital Charge Code |
905104195
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Central Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
|
|
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: Blue Shield of California EPN |
$69.42
|
| 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: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$86.71
|
| 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 |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC CONVERT INSTEP TO VELCRO CLOSU
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT L3580
|
| Hospital Charge Code |
905353580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$257.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$257.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$71.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$71.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.80
|
| Rate for Payer: BCBS Transplant Transplant |
$78.00
|
| Rate for Payer: Blue Shield of California Commercial |
$97.50
|
| Rate for Payer: Blue Shield of California EPN |
$70.72
|
| 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: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$97.50
|
| Rate for Payer: IEHP medi-cal |
$45.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.30
|
| 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 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 |
$65.00
|
| Rate for Payer: United Healthcare All Other HMO |
$65.00
|
| Rate for Payer: United Healthcare HMO Rider |
$65.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.50
|
| Rate for Payer: Vantage Medical Group Senior |
$110.50
|
|
|
HC COOMBS TEST DIRECT
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC COOMBS TEST DIRECT
|
Facility
OP
|
$271.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
900904541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.67
|
| Rate for Payer: BCBS Transplant Transplant |
$162.60
|
| Rate for Payer: Blue Shield of California Commercial |
$167.48
|
| Rate for Payer: Blue Shield of California EPN |
$131.71
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: Cigna of CA HMO |
$173.44
|
| Rate for Payer: Cigna of CA PPO |
$200.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$203.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: IEHP medi-cal |
$126.09
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Innovage PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$162.60
|
| Rate for Payer: Riverside University Health MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
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 |
$129.93 |
| Max. Negotiated Rate |
$1,375.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,375.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$499.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$499.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$440.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$537.04
|
| Rate for Payer: BCBS Transplant Transplant |
$545.40
|
| Rate for Payer: Blue Shield of California Commercial |
$571.76
|
| Rate for Payer: Blue Shield of California EPN |
$444.50
|
| 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: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$681.75
|
| Rate for Payer: IEHP medi-cal |
$129.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.30
|
| 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: Riverside University Health 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 |
$454.50
|
| Rate for Payer: United Healthcare All Other HMO |
$454.50
|
| Rate for Payer: United Healthcare HMO Rider |
$454.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$454.50
|
| 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 2.0X1.0
|
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: Blue Shield of California Commercial |
$681.75
|
| Rate for Payer: Blue Shield of California EPN |
$485.41
|
| 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 Transplant |
$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: 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
|
|
|
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: Blue Shield of California Commercial |
$727.50
|
| Rate for Payer: Blue Shield of California EPN |
$517.98
|
| 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 Transplant |
$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: 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
|
|
|
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 |
$129.93 |
| Max. Negotiated Rate |
$1,375.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,375.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$824.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$533.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$533.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$469.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$573.08
|
| Rate for Payer: BCBS Transplant Transplant |
$582.00
|
| Rate for Payer: Blue Shield of California Commercial |
$610.13
|
| Rate for Payer: Blue Shield of California EPN |
$474.33
|
| 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: EPIC Health Plan Commercial |
$388.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$727.50
|
| Rate for Payer: IEHP medi-cal |
$129.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$646.99
|
| 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: Riverside University Health 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 |
$485.00
|
| Rate for Payer: United Healthcare All Other HMO |
$485.00
|
| Rate for Payer: United Healthcare HMO Rider |
$485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$485.00
|
| 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 |
$129.93 |
| Max. Negotiated Rate |
$1,375.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,375.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$552.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$357.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$357.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$314.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.02
|
| Rate for Payer: BCBS Transplant Transplant |
$390.00
|
| Rate for Payer: Blue Shield of California Commercial |
$408.85
|
| Rate for Payer: Blue Shield of California EPN |
$317.85
|
| 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: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$487.50
|
| Rate for Payer: IEHP medi-cal |
$129.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$433.55
|
| 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: Riverside University Health 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 |
$325.00
|
| Rate for Payer: United Healthcare All Other HMO |
$325.00
|
| Rate for Payer: United Healthcare HMO Rider |
$325.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$325.00
|
| 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: Blue Shield of California Commercial |
$487.50
|
| Rate for Payer: Blue Shield of California EPN |
$347.10
|
| 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 Transplant |
$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: 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
|
|
|
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: Blue Shield of California Commercial |
$353.25
|
| Rate for Payer: Blue Shield of California EPN |
$251.51
|
| 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 Transplant |
$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: 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
|
|
|
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 |
$1,375.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,375.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$400.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$259.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$259.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$228.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.27
|
| Rate for Payer: BCBS Transplant Transplant |
$282.60
|
| Rate for Payer: Blue Shield of California Commercial |
$296.26
|
| Rate for Payer: Blue Shield of California EPN |
$230.32
|
| 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: EPIC Health Plan Commercial |
$188.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$353.25
|
| Rate for Payer: IEHP medi-cal |
$129.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.16
|
| 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: Riverside University Health 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 |
$235.50
|
| Rate for Payer: United Healthcare All Other HMO |
$235.50
|
| Rate for Payer: United Healthcare HMO Rider |
$235.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.50
|
| 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
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: Blue Shield of California Commercial |
$342.75
|
| Rate for Payer: Blue Shield of California EPN |
$244.04
|
| 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 Transplant |
$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: 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
|
|
|
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 |
$1,375.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,375.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$388.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$251.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$251.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.00
|
| Rate for Payer: BCBS Transplant Transplant |
$274.20
|
| Rate for Payer: Blue Shield of California Commercial |
$287.45
|
| Rate for Payer: Blue Shield of California EPN |
$223.47
|
| 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: EPIC Health Plan Commercial |
$182.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$342.75
|
| Rate for Payer: IEHP medi-cal |
$129.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.82
|
| 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: Riverside University Health 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 |
$228.50
|
| Rate for Payer: United Healthcare All Other HMO |
$228.50
|
| Rate for Payer: United Healthcare HMO Rider |
$228.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$388.45
|
| Rate for Payer: Vantage Medical Group Senior |
$388.45
|
|
|
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 |
$129.93 |
| Max. Negotiated Rate |
$1,375.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,375.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$499.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$499.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$440.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$537.04
|
| Rate for Payer: BCBS Transplant Transplant |
$545.40
|
| Rate for Payer: Blue Shield of California Commercial |
$571.76
|
| Rate for Payer: Blue Shield of California EPN |
$444.50
|
| 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: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$681.75
|
| Rate for Payer: IEHP medi-cal |
$129.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.30
|
| 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: Riverside University Health 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 |
$454.50
|
| Rate for Payer: United Healthcare All Other HMO |
$454.50
|
| Rate for Payer: United Healthcare HMO Rider |
$454.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$454.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$772.65
|
| Rate for Payer: Vantage Medical Group Senior |
$772.65
|
|
|
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: Blue Shield of California Commercial |
$681.75
|
| Rate for Payer: Blue Shield of California EPN |
$485.41
|
| 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 Transplant |
$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: 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
|
|
