|
HC IMPL AROA MATRIX 10CM W X 10CM L 1MM THK
|
Facility
|
IP
|
$4,501.00
|
|
|
Service Code
|
CPT Q4100
|
| Hospital Charge Code |
900104001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$900.20 |
| Max. Negotiated Rate |
$4,050.90 |
| Rate for Payer: Adventist Health Commercial |
$900.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,479.27
|
| Rate for Payer: Blue Shield of California EPN |
$2,268.50
|
| Rate for Payer: Cash Price |
$2,025.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,600.80
|
| Rate for Payer: Cigna of CA HMO |
$3,150.70
|
| Rate for Payer: Cigna of CA PPO |
$3,150.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.40
|
| Rate for Payer: Galaxy Health WC |
$3,825.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,050.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,714.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.20
|
| Rate for Payer: Multiplan Commercial |
$3,375.75
|
| Rate for Payer: Networks By Design Commercial |
$2,250.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,689.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,608.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.08
|
|
|
HC IMPL AROA MATRIX 10CM W X 10CM L 1MM THK
|
Facility
|
OP
|
$4,501.00
|
|
|
Service Code
|
CPT Q4100
|
| Hospital Charge Code |
900104001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$900.20 |
| Max. Negotiated Rate |
$4,050.90 |
| Rate for Payer: Adventist Health Commercial |
$900.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,733.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,825.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,475.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,375.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,179.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,643.44
|
| Rate for Payer: Blue Shield of California Commercial |
$2,750.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,795.90
|
| Rate for Payer: Cash Price |
$2,025.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,600.80
|
| Rate for Payer: Cigna of CA HMO |
$3,150.70
|
| Rate for Payer: Cigna of CA PPO |
$3,150.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,825.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,825.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,825.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.40
|
| Rate for Payer: Galaxy Health WC |
$3,825.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,700.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,050.90
|
| Rate for Payer: InnovAge PACE Commercial |
$2,250.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,150.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,150.70
|
| Rate for Payer: Multiplan Commercial |
$3,375.75
|
| Rate for Payer: Networks By Design Commercial |
$2,250.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,825.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,800.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,700.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,700.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,689.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,608.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,825.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,825.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,825.85
|
|
|
HC IMPL AROA MATRIX 10CM W X 20CM L 1MM THK
|
Facility
|
OP
|
$3,510.00
|
|
|
Service Code
|
CPT Q4100
|
| 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: Aetna of CA HMO/PPO |
$2,131.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,930.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,632.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,699.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,061.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,144.61
|
| Rate for Payer: Blue Shield of California EPN |
$1,400.49
|
| 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 |
$2,983.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,983.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,983.50
|
| 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: InnovAge PACE Commercial |
$1,755.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,172.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,457.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,457.00
|
| 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: Riverside University Health System MISP |
$1,404.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,983.50
|
|
|
HC IMPL AROA MATRIX 10CM W X 20CM L 1MM THK
|
Facility
|
IP
|
$3,510.00
|
|
|
Service Code
|
CPT Q4100
|
| 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 |
$2,713.23
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,337.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,172.69
|
| 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 MYRIAD 20CMX20CM
|
Facility
|
IP
|
$11,905.00
|
|
|
Service Code
|
CPT Q4100
|
| 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 |
$9,202.57
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$7,940.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,535.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,369.19
|
| 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 Q4100
|
| 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: Aetna of CA HMO/PPO |
$7,229.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,119.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,547.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,928.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,764.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,991.81
|
| Rate for Payer: Blue Shield of California Commercial |
$7,273.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,750.10
|
| 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 |
$10,119.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,119.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,119.25
|
| 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: InnovAge PACE Commercial |
$5,952.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,940.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,369.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,381.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,333.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,333.50
|
| 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: Riverside University Health System MISP |
$4,762.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$10,119.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,119.25
|
| Rate for Payer: Vantage Medical Group Senior |
$10,119.25
|
|
|
HC IMPL AROA MYRIAD 7CMX10CM
|
Facility
|
IP
|
$2,633.00
|
|
|
Service Code
|
CPT Q4100
|
| 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 |
$2,035.31
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,756.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,003.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,629.83
|
| 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 Q4100
|
| 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: Aetna of CA HMO/PPO |
$1,599.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,238.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,448.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,974.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,274.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,546.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,608.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,050.57
|
| 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 |
$2,238.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,238.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,238.05
|
| 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: InnovAge PACE Commercial |
$1,316.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,756.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,629.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,843.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,843.10
|
| 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: Riverside University Health System MISP |
$1,053.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,238.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,238.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,238.05
|
|
|
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 |
$9.09 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.86
|
| Rate for Payer: Blue Shield of California Commercial |
$54.99
|
| 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 |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$9.09
|
| Rate for Payer: InnovAge PACE Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| 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: Riverside University Health System MISP |
$36.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
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 |
$69.57
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.71
|
| 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 DRSNG OASIS WND MATRIX 3X3.5CM
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101458
|
|
Hospital Revenue Code
|
636
|
| 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 |
$58.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| 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
|
636
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.63
|
| Rate for Payer: Blue Shield of California Commercial |
$46.44
|
| Rate for Payer: Blue Shield of California EPN |
$30.32
|
| 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 |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$12.01
|
| Rate for Payer: InnovAge PACE Commercial |
$38.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| 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: Riverside University Health System MISP |
$30.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X7CM
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.63
|
| Rate for Payer: Blue Shield of California Commercial |
$46.44
|
| Rate for Payer: Blue Shield of California EPN |
$30.32
|
| 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 |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$12.01
|
| Rate for Payer: InnovAge PACE Commercial |
$38.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| 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: Riverside University Health System MISP |
$30.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X7CM
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101459
|
|
Hospital Revenue Code
|
636
|
| 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 |
$58.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| 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 GORE SEPTALOCC CARDIOFORM
|
Facility
|
OP
|
$17,493.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,498.60 |
| Max. Negotiated Rate |
$15,743.70 |
| Rate for Payer: Adventist Health Commercial |
$3,498.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,869.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,621.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,119.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,987.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,685.87
|
| Rate for Payer: Blue Shield of California Commercial |
$13,522.09
|
| Rate for Payer: Blue Shield of California EPN |
$8,816.47
|
| Rate for Payer: Cash Price |
$7,871.85
|
| Rate for Payer: Central Health Plan Commercial |
$13,994.40
|
| Rate for Payer: Cigna of CA HMO |
$12,245.10
|
| Rate for Payer: Cigna of CA PPO |
$12,245.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,869.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,869.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,869.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,997.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,997.20
|
| Rate for Payer: Galaxy Health WC |
$14,869.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,495.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,743.70
|
| Rate for Payer: InnovAge PACE Commercial |
$8,746.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,667.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,664.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,828.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,498.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,245.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,245.10
|
| Rate for Payer: Multiplan Commercial |
$13,119.75
|
| Rate for Payer: Networks By Design Commercial |
$8,746.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,869.05
|
| Rate for Payer: Riverside University Health System MISP |
$6,997.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,495.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,495.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,565.12
|
| Rate for Payer: United Healthcare All Other HMO |
$6,390.19
|
| Rate for Payer: United Healthcare HMO Rider |
$6,252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,728.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,869.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,869.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14,869.05
|
|
|
HC IMPL GORE SEPTALOCC CARDIOFORM
|
Facility
|
IP
|
$17,493.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,498.60 |
| Max. Negotiated Rate |
$15,743.70 |
| Rate for Payer: Adventist Health Commercial |
$3,498.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13,522.09
|
| Rate for Payer: Blue Shield of California EPN |
$8,816.47
|
| Rate for Payer: Cash Price |
$7,871.85
|
| Rate for Payer: Central Health Plan Commercial |
$13,994.40
|
| Rate for Payer: Cigna of CA HMO |
$12,245.10
|
| Rate for Payer: Cigna of CA PPO |
$12,245.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,997.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,997.20
|
| Rate for Payer: Galaxy Health WC |
$14,869.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,495.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,743.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,667.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,664.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,828.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,498.60
|
| Rate for Payer: Multiplan Commercial |
$13,119.75
|
| Rate for Payer: Networks By Design Commercial |
$8,746.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,869.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,565.12
|
| Rate for Payer: United Healthcare All Other HMO |
$6,390.19
|
| Rate for Payer: United Healthcare HMO Rider |
$6,252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,728.96
|
|
|
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 |
$37.50 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Adventist Health Commercial |
$128.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$391.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$354.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$483.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$311.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$378.22
|
| Rate for Payer: Blue Shield of California Commercial |
$393.48
|
| 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 |
$547.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$547.40
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$37.50
|
| Rate for Payer: InnovAge PACE Commercial |
$322.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$450.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$450.80
|
| 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: Riverside University Health System MISP |
$257.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.40
|
| Rate for Payer: Vantage Medical Group Senior |
$547.40
|
|
|
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 |
$497.81
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.64
|
| 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 |
$262.05
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| 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 |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$205.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.09
|
| Rate for Payer: Blue Shield of California Commercial |
$207.13
|
| 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 |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$136.37
|
| Rate for Payer: InnovAge PACE Commercial |
$169.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| 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: Riverside University Health System MISP |
$135.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC IMPL GRAFT DERMAGRAFT 5CM X 7.5CM
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT Q4106
|
| Hospital Charge Code |
900101460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Blue Shield of California Commercial |
$102.81
|
| Rate for Payer: Blue Shield of California EPN |
$67.03
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$93.10
|
| Rate for Payer: Cigna of CA PPO |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$66.50
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.91
|
| Rate for Payer: United Healthcare All Other HMO |
$48.58
|
| Rate for Payer: United Healthcare HMO Rider |
$47.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.56
|
|
|
HC IMPL GRAFT DERMAGRAFT 5CM X 7.5CM
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT Q4106
|
| Hospital Charge Code |
900101460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.11
|
| Rate for Payer: Blue Shield of California Commercial |
$81.26
|
| Rate for Payer: Blue Shield of California EPN |
$53.07
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$93.10
|
| Rate for Payer: Cigna of CA PPO |
$93.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.95
|
| Rate for Payer: InnovAge PACE Commercial |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.10
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$66.50
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Riverside University Health System MISP |
$53.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.91
|
| Rate for Payer: United Healthcare All Other HMO |
$48.58
|
| Rate for Payer: United Healthcare HMO Rider |
$47.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.05
|
| Rate for Payer: Vantage Medical Group Senior |
$113.05
|
|
|
HC IMPL GRAFT EPIFIX 14MM DISK
|
Facility
|
OP
|
$1,378.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.33 |
| Max. Negotiated Rate |
$1,240.20 |
| Rate for Payer: Adventist Health Commercial |
$275.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$836.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,171.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$757.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,033.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$667.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$809.30
|
| Rate for Payer: Blue Shield of California Commercial |
$841.96
|
| Rate for Payer: Blue Shield of California EPN |
$549.82
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,102.40
|
| Rate for Payer: Cigna of CA HMO |
$964.60
|
| Rate for Payer: Cigna of CA PPO |
$964.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,171.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,171.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,171.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$551.20
|
| Rate for Payer: Galaxy Health WC |
$1,171.30
|
| Rate for Payer: Global Benefits Group Commercial |
$826.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,240.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.33
|
| Rate for Payer: InnovAge PACE Commercial |
$689.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$852.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$964.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$964.60
|
| Rate for Payer: Multiplan Commercial |
$1,033.50
|
| Rate for Payer: Networks By Design Commercial |
$689.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,171.30
|
| Rate for Payer: Riverside University Health System MISP |
$551.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$826.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$826.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$517.16
|
| Rate for Payer: United Healthcare All Other HMO |
$503.38
|
| Rate for Payer: United Healthcare HMO Rider |
$492.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$451.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,171.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,171.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,171.30
|
|
|
HC IMPL GRAFT EPIFIX 14MM DISK
|
Facility
|
IP
|
$1,378.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$1,240.20 |
| Rate for Payer: Adventist Health Commercial |
$275.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,065.19
|
| Rate for Payer: Blue Shield of California EPN |
$694.51
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,102.40
|
| Rate for Payer: Cigna of CA HMO |
$964.60
|
| Rate for Payer: Cigna of CA PPO |
$964.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$551.20
|
| Rate for Payer: Galaxy Health WC |
$1,171.30
|
| Rate for Payer: Global Benefits Group Commercial |
$826.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,240.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$852.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.60
|
| Rate for Payer: Multiplan Commercial |
$1,033.50
|
| Rate for Payer: Networks By Design Commercial |
$689.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,171.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$517.16
|
| Rate for Payer: United Healthcare All Other HMO |
$503.38
|
| Rate for Payer: United Healthcare HMO Rider |
$492.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$451.30
|
|
|
HC IMPL GRAFT EPIFIX 18MM DISK
|
Facility
|
OP
|
$2,673.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.33 |
| Max. Negotiated Rate |
$2,405.70 |
| Rate for Payer: Adventist Health Commercial |
$534.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,623.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,272.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,470.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,004.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,294.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,569.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,633.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,066.53
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,138.40
|
| Rate for Payer: Cigna of CA HMO |
$1,871.10
|
| Rate for Payer: Cigna of CA PPO |
$1,871.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,272.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,272.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,272.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,069.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,069.20
|
| Rate for Payer: Galaxy Health WC |
$2,272.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,603.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,405.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.33
|
| Rate for Payer: InnovAge PACE Commercial |
$1,336.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,782.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,654.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,871.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,871.10
|
| Rate for Payer: Multiplan Commercial |
$2,004.75
|
| Rate for Payer: Networks By Design Commercial |
$1,336.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,272.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,069.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,603.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,603.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,003.18
|
| Rate for Payer: United Healthcare All Other HMO |
$976.45
|
| Rate for Payer: United Healthcare HMO Rider |
$955.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$875.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,272.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,272.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,272.05
|
|
