|
HC IMPL AROA MATRIX 10CM W X 20CM L 1MM THK
|
Facility
|
IP
|
$3,510.00
|
|
|
Service Code
|
CPT A2032
|
| Hospital Charge Code |
900104000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$3,159.00 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,815.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,769.04
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,808.00
|
| Rate for Payer: Cigna of CA HMO |
$2,457.00
|
| Rate for Payer: Cigna of CA PPO |
$2,457.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,457.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,159.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,228.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,070.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,317.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,149.53
|
|
|
HC IMPL AROA MATRIX 10CM W X 20CM L 1MM THK
|
Facility
|
OP
|
$3,510.00
|
|
|
Service Code
|
CPT A2032
|
| Hospital Charge Code |
900104000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$3,159.00 |
| Rate for Payer: Adventist Health Commercial |
$702.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,131.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,699.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,041.77
|
| Rate for Payer: Blue Shield of California Commercial |
$2,225.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,400.49
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,808.00
|
| Rate for Payer: Cigna of CA HMO |
$2,457.00
|
| Rate for Payer: Cigna of CA PPO |
$2,457.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,457.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,159.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,228.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,106.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,106.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,317.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,149.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL AROA MYRIAD 20CMX20CM
|
Facility
|
IP
|
$11,905.00
|
|
|
Service Code
|
CPT A2032
|
| Hospital Charge Code |
900104003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,381.00 |
| Max. Negotiated Rate |
$10,714.50 |
| Rate for Payer: Adventist Health Commercial |
$2,381.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,547.81
|
| Rate for Payer: Blue Shield of California EPN |
$6,000.12
|
| Rate for Payer: Cash Price |
$5,357.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,524.00
|
| Rate for Payer: Cigna of CA HMO |
$8,333.50
|
| Rate for Payer: Cigna of CA PPO |
$8,333.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,333.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,762.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,762.00
|
| Rate for Payer: Galaxy Health WC |
$10,119.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,143.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,714.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,559.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,023.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,381.00
|
| Rate for Payer: Multiplan Commercial |
$8,928.75
|
| Rate for Payer: Networks By Design Commercial |
$5,952.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,119.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,467.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4,348.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4,254.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,898.89
|
|
|
HC IMPL AROA MYRIAD 20CMX20CM
|
Facility
|
OP
|
$11,905.00
|
|
|
Service Code
|
CPT A2032
|
| Hospital Charge Code |
900104003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$10,714.50 |
| Rate for Payer: Adventist Health Commercial |
$2,381.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,229.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,764.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,925.14
|
| Rate for Payer: Blue Shield of California Commercial |
$7,547.77
|
| Rate for Payer: Blue Shield of California EPN |
$4,750.10
|
| Rate for Payer: Cash Price |
$5,357.25
|
| Rate for Payer: Cash Price |
$5,357.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,524.00
|
| Rate for Payer: Cigna of CA HMO |
$8,333.50
|
| Rate for Payer: Cigna of CA PPO |
$8,333.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,333.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$10,119.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,143.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,714.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,559.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,381.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$8,928.75
|
| Rate for Payer: Networks By Design Commercial |
$5,952.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$10,119.25
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,143.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,143.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,467.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4,348.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4,254.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,898.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL AROA MYRIAD 7CMX10CM
|
Facility
|
IP
|
$2,633.00
|
|
|
Service Code
|
CPT A2032
|
| Hospital Charge Code |
900104002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$526.60 |
| Max. Negotiated Rate |
$2,369.70 |
| Rate for Payer: Adventist Health Commercial |
$526.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,111.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,327.03
|
| Rate for Payer: Cash Price |
$1,184.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,106.40
|
| Rate for Payer: Cigna of CA HMO |
$1,843.10
|
| Rate for Payer: Cigna of CA PPO |
$1,843.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,843.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,053.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,053.20
|
| Rate for Payer: Galaxy Health WC |
$2,238.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,579.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,369.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,671.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,553.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.60
|
| Rate for Payer: Multiplan Commercial |
$1,974.75
|
| Rate for Payer: Networks By Design Commercial |
$1,316.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,238.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$988.16
|
| Rate for Payer: United Healthcare All Other HMO |
$961.83
|
| Rate for Payer: United Healthcare HMO Rider |
$941.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$862.31
|
|
|
HC IMPL AROA MYRIAD 7CMX10CM
|
Facility
|
OP
|
$2,633.00
|
|
|
Service Code
|
CPT A2032
|
| Hospital Charge Code |
900104002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$2,369.70 |
| Rate for Payer: Adventist Health Commercial |
$526.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,599.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,274.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,531.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,669.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,050.57
|
| Rate for Payer: Cash Price |
$1,184.85
|
| Rate for Payer: Cash Price |
$1,184.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,106.40
|
| Rate for Payer: Cigna of CA HMO |
$1,843.10
|
| Rate for Payer: Cigna of CA PPO |
$1,843.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,843.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$2,238.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,579.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,369.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,671.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$1,974.75
|
| Rate for Payer: Networks By Design Commercial |
$1,316.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$2,238.05
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,579.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,579.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$988.16
|
| Rate for Payer: United Healthcare All Other HMO |
$961.83
|
| Rate for Payer: United Healthcare HMO Rider |
$941.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$862.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL DRESSING WOUND 5X7CM OASIS ULTRA
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT Q4124
|
| Hospital Charge Code |
900101468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$72.18
|
| Rate for Payer: Blue Shield of California EPN |
$45.36
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
|
|
HC IMPL DRESSING WOUND 5X7CM OASIS ULTRA
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT Q4124
|
| Hospital Charge Code |
900101468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.96
|
| Rate for Payer: Blue Shield of California Commercial |
$57.06
|
| Rate for Payer: Blue Shield of California EPN |
$35.91
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X3.5CM
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Blue Shield of California Commercial |
$60.95
|
| Rate for Payer: Blue Shield of California EPN |
$38.30
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$38.00
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.52
|
| Rate for Payer: United Healthcare All Other HMO |
$27.76
|
| Rate for Payer: United Healthcare HMO Rider |
$27.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.89
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X3.5CM
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.68
|
| Rate for Payer: Blue Shield of California Commercial |
$60.95
|
| Rate for Payer: Blue Shield of California EPN |
$38.30
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$38.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.52
|
| Rate for Payer: United Healthcare All Other HMO |
$27.76
|
| Rate for Payer: United Healthcare HMO Rider |
$27.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X7CM
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Blue Shield of California Commercial |
$60.95
|
| Rate for Payer: Blue Shield of California EPN |
$38.30
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$38.00
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.52
|
| Rate for Payer: United Healthcare All Other HMO |
$27.76
|
| Rate for Payer: United Healthcare HMO Rider |
$27.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.89
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X7CM
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.68
|
| Rate for Payer: Blue Shield of California Commercial |
$60.95
|
| Rate for Payer: Blue Shield of California EPN |
$38.30
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$38.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.52
|
| Rate for Payer: United Healthcare All Other HMO |
$27.76
|
| Rate for Payer: United Healthcare HMO Rider |
$27.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL GRAFIX CORE 2 X 3 CM 6 UNITS
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
900101532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.21
|
| Rate for Payer: Blue Shield of California Commercial |
$408.30
|
| Rate for Payer: Blue Shield of California EPN |
$256.96
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| Rate for Payer: Cigna of CA HMO |
$450.80
|
| Rate for Payer: Cigna of CA PPO |
$450.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: Networks By Design Commercial |
$322.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.69
|
| Rate for Payer: United Healthcare All Other HMO |
$235.25
|
| Rate for Payer: United Healthcare HMO Rider |
$230.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL GRAFIX CORE 2 X 3 CM 6 UNITS
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
900101532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Blue Shield of California Commercial |
$516.49
|
| Rate for Payer: Blue Shield of California EPN |
$324.58
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| Rate for Payer: Cigna of CA HMO |
$450.80
|
| Rate for Payer: Cigna of CA PPO |
$450.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Senior |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: Networks By Design Commercial |
$322.00
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.69
|
| Rate for Payer: United Healthcare All Other HMO |
$235.25
|
| Rate for Payer: United Healthcare HMO Rider |
$230.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.91
|
|
|
HC IMPL GRAFIX PRIME 2 X 3 CM 6 UNITS
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101533
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Blue Shield of California Commercial |
$271.88
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC IMPL GRAFIX PRIME 2 X 3 CM 6 UNITS
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101533
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$845.07 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$845.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.21
|
| Rate for Payer: Blue Shield of California Commercial |
$214.93
|
| Rate for Payer: Blue Shield of California EPN |
$135.26
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$230.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL GRAFT EPIFIX 14MM DISK
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$981.22 |
| Rate for Payer: Adventist Health Commercial |
$163.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$981.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$396.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$476.41
|
| Rate for Payer: Blue Shield of California Commercial |
$519.25
|
| Rate for Payer: Blue Shield of California EPN |
$326.78
|
| Rate for Payer: Cash Price |
$368.55
|
| Rate for Payer: Cash Price |
$368.55
|
| Rate for Payer: Central Health Plan Commercial |
$655.20
|
| Rate for Payer: Cigna of CA HMO |
$573.30
|
| Rate for Payer: Cigna of CA PPO |
$573.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$573.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$696.15
|
| Rate for Payer: Global Benefits Group Commercial |
$491.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$737.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$520.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$614.25
|
| Rate for Payer: Networks By Design Commercial |
$409.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$696.15
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$491.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$491.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$307.37
|
| Rate for Payer: United Healthcare All Other HMO |
$299.18
|
| Rate for Payer: United Healthcare HMO Rider |
$292.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL GRAFT EPIFIX 14MM DISK
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$737.10 |
| Rate for Payer: Adventist Health Commercial |
$163.80
|
| Rate for Payer: Blue Shield of California Commercial |
$656.84
|
| Rate for Payer: Blue Shield of California EPN |
$412.78
|
| Rate for Payer: Cash Price |
$368.55
|
| Rate for Payer: Central Health Plan Commercial |
$655.20
|
| Rate for Payer: Cigna of CA HMO |
$573.30
|
| Rate for Payer: Cigna of CA PPO |
$573.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$573.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.60
|
| Rate for Payer: EPIC Health Plan Senior |
$327.60
|
| Rate for Payer: Galaxy Health WC |
$696.15
|
| Rate for Payer: Global Benefits Group Commercial |
$491.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$737.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$520.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$483.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$614.25
|
| Rate for Payer: Networks By Design Commercial |
$409.50
|
| Rate for Payer: Prime Health Services Commercial |
$696.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$307.37
|
| Rate for Payer: United Healthcare All Other HMO |
$299.18
|
| Rate for Payer: United Healthcare HMO Rider |
$292.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.22
|
|
|
HC IMPL GRAFT EPIFIX 18MM DISK
|
Facility
|
IP
|
$1,228.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$1,105.20 |
| Rate for Payer: Adventist Health Commercial |
$245.60
|
| Rate for Payer: Blue Shield of California Commercial |
$984.86
|
| Rate for Payer: Blue Shield of California EPN |
$618.91
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Central Health Plan Commercial |
$982.40
|
| Rate for Payer: Cigna of CA HMO |
$859.60
|
| Rate for Payer: Cigna of CA PPO |
$859.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$859.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$491.20
|
| Rate for Payer: Galaxy Health WC |
$1,043.80
|
| Rate for Payer: Global Benefits Group Commercial |
$736.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,105.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$779.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$724.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.60
|
| Rate for Payer: Multiplan Commercial |
$921.00
|
| Rate for Payer: Networks By Design Commercial |
$614.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,043.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.87
|
| Rate for Payer: United Healthcare All Other HMO |
$448.59
|
| Rate for Payer: United Healthcare HMO Rider |
$438.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$402.17
|
|
|
HC IMPL GRAFT EPIFIX 18MM DISK
|
Facility
|
OP
|
$1,228.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$1,105.20 |
| Rate for Payer: Adventist Health Commercial |
$245.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$981.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$594.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$714.33
|
| Rate for Payer: Blue Shield of California Commercial |
$778.55
|
| Rate for Payer: Blue Shield of California EPN |
$489.97
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Central Health Plan Commercial |
$982.40
|
| Rate for Payer: Cigna of CA HMO |
$859.60
|
| Rate for Payer: Cigna of CA PPO |
$859.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$859.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$1,043.80
|
| Rate for Payer: Global Benefits Group Commercial |
$736.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,105.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$779.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$921.00
|
| Rate for Payer: Networks By Design Commercial |
$614.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$1,043.80
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$736.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$736.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$460.87
|
| Rate for Payer: United Healthcare All Other HMO |
$448.59
|
| Rate for Payer: United Healthcare HMO Rider |
$438.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$402.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL GRAFT EPIFIX 2X2 CM
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.80 |
| Max. Negotiated Rate |
$981.22 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$981.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$198.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.92
|
| Rate for Payer: Blue Shield of California Commercial |
$259.31
|
| Rate for Payer: Blue Shield of California EPN |
$163.19
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Central Health Plan Commercial |
$327.20
|
| Rate for Payer: Cigna of CA HMO |
$286.30
|
| Rate for Payer: Cigna of CA PPO |
$286.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$286.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$368.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: Networks By Design Commercial |
$204.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$245.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$245.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$149.41
|
| Rate for Payer: United Healthcare HMO Rider |
$146.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL GRAFT EPIFIX 2X2 CM
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.80 |
| Max. Negotiated Rate |
$368.10 |
| Rate for Payer: Adventist Health Commercial |
$81.80
|
| Rate for Payer: Blue Shield of California Commercial |
$328.02
|
| Rate for Payer: Blue Shield of California EPN |
$206.14
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Central Health Plan Commercial |
$327.20
|
| Rate for Payer: Cigna of CA HMO |
$286.30
|
| Rate for Payer: Cigna of CA PPO |
$286.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$286.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.60
|
| Rate for Payer: EPIC Health Plan Senior |
$163.60
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$368.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: Networks By Design Commercial |
$204.50
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$149.41
|
| Rate for Payer: United Healthcare HMO Rider |
$146.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.95
|
|
|
HC IMPL GRAFT EPIFIX 2X4 CM
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Blue Shield of California Commercial |
$278.29
|
| Rate for Payer: Blue Shield of California EPN |
$174.89
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$220.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$204.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
|
|
HC IMPL GRAFT EPIFIX 2X4 CM
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$981.22 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$160.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$981.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.85
|
| Rate for Payer: Blue Shield of California Commercial |
$220.00
|
| Rate for Payer: Blue Shield of California EPN |
$138.45
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.10
|
| Rate for Payer: EPIC Health Plan Senior |
$176.07
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$220.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$160.06
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: Prime Health Services Medicare |
$169.66
|
| Rate for Payer: Riverside University Health System MISP |
$176.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$160.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL GRAFT EPIFIX 3X4 CM
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$200.70 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Blue Shield of California Commercial |
$178.85
|
| Rate for Payer: Blue Shield of California EPN |
$112.39
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: Cigna of CA HMO |
$156.10
|
| Rate for Payer: Cigna of CA PPO |
$156.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$156.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Networks By Design Commercial |
$111.50
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.69
|
| Rate for Payer: United Healthcare All Other HMO |
$81.46
|
| Rate for Payer: United Healthcare HMO Rider |
$79.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.03
|
|
