|
HC IMPL GRAFT EPIFIX 3X4 CM
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$660.60 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$445.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$623.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$403.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$550.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$355.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.08
|
| Rate for Payer: Blue Shield of California Commercial |
$448.47
|
| Rate for Payer: Blue Shield of California EPN |
$292.87
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: Central Health Plan Commercial |
$587.20
|
| Rate for Payer: Cigna of CA HMO |
$513.80
|
| Rate for Payer: Cigna of CA PPO |
$513.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$623.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$623.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$623.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.60
|
| Rate for Payer: EPIC Health Plan Senior |
$293.60
|
| Rate for Payer: Galaxy Health WC |
$623.90
|
| Rate for Payer: Global Benefits Group Commercial |
$440.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$660.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.33
|
| Rate for Payer: InnovAge PACE Commercial |
$367.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$489.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$454.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$513.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$513.80
|
| Rate for Payer: Multiplan Commercial |
$550.50
|
| Rate for Payer: Networks By Design Commercial |
$367.00
|
| Rate for Payer: Prime Health Services Commercial |
$623.90
|
| Rate for Payer: Riverside University Health System MISP |
$293.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$440.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$440.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$275.47
|
| Rate for Payer: United Healthcare All Other HMO |
$268.13
|
| Rate for Payer: United Healthcare HMO Rider |
$262.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$623.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$623.90
|
| Rate for Payer: Vantage Medical Group Senior |
$623.90
|
|
|
HC IMPL GRAFT EPIFIX 4X4.5 CM MESH
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$288.04 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.44
|
| Rate for Payer: Blue Shield of California Commercial |
$132.59
|
| Rate for Payer: Blue Shield of California EPN |
$86.58
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$151.90
|
| Rate for Payer: Cigna of CA PPO |
$151.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.33
|
| Rate for Payer: InnovAge PACE Commercial |
$108.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$108.50
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Riverside University Health System MISP |
$86.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.44
|
| Rate for Payer: United Healthcare All Other HMO |
$79.27
|
| Rate for Payer: United Healthcare HMO Rider |
$77.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC IMPL GRAFT EPIFIX 4X4.5 CM MESH
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Adventist Health Commercial |
$43.40
|
| Rate for Payer: Blue Shield of California Commercial |
$167.74
|
| Rate for Payer: Blue Shield of California EPN |
$109.37
|
| Rate for Payer: Cash Price |
$119.35
|
| Rate for Payer: Central Health Plan Commercial |
$173.60
|
| Rate for Payer: Cigna of CA HMO |
$151.90
|
| Rate for Payer: Cigna of CA PPO |
$151.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Senior |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$162.75
|
| Rate for Payer: Networks By Design Commercial |
$108.50
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.44
|
| Rate for Payer: United Healthcare All Other HMO |
$79.27
|
| Rate for Payer: United Healthcare HMO Rider |
$77.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.07
|
|
|
HC IMPL GRAFT EPIFIX 4X4 CM
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$450.90 |
| Rate for Payer: Adventist Health Commercial |
$100.20
|
| Rate for Payer: Blue Shield of California Commercial |
$387.27
|
| Rate for Payer: Blue Shield of California EPN |
$252.50
|
| Rate for Payer: Cash Price |
$275.55
|
| Rate for Payer: Central Health Plan Commercial |
$400.80
|
| Rate for Payer: Cigna of CA HMO |
$350.70
|
| Rate for Payer: Cigna of CA PPO |
$350.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.40
|
| Rate for Payer: EPIC Health Plan Senior |
$200.40
|
| Rate for Payer: Galaxy Health WC |
$425.85
|
| Rate for Payer: Global Benefits Group Commercial |
$300.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.20
|
| Rate for Payer: Multiplan Commercial |
$375.75
|
| Rate for Payer: Networks By Design Commercial |
$250.50
|
| Rate for Payer: Prime Health Services Commercial |
$425.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.03
|
| Rate for Payer: United Healthcare All Other HMO |
$183.02
|
| Rate for Payer: United Healthcare HMO Rider |
$179.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.08
|
|
|
HC IMPL GRAFT EPIFIX 4X4 CM
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$450.90 |
| Rate for Payer: Adventist Health Commercial |
$100.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$304.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$425.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.24
|
| Rate for Payer: Blue Shield of California Commercial |
$306.11
|
| Rate for Payer: Blue Shield of California EPN |
$199.90
|
| Rate for Payer: Cash Price |
$275.55
|
| Rate for Payer: Cash Price |
$275.55
|
| Rate for Payer: Central Health Plan Commercial |
$400.80
|
| Rate for Payer: Cigna of CA HMO |
$350.70
|
| Rate for Payer: Cigna of CA PPO |
$350.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$425.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.40
|
| Rate for Payer: EPIC Health Plan Senior |
$200.40
|
| Rate for Payer: Galaxy Health WC |
$425.85
|
| Rate for Payer: Global Benefits Group Commercial |
$300.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.33
|
| Rate for Payer: InnovAge PACE Commercial |
$250.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$350.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$350.70
|
| Rate for Payer: Multiplan Commercial |
$375.75
|
| Rate for Payer: Networks By Design Commercial |
$250.50
|
| Rate for Payer: Prime Health Services Commercial |
$425.85
|
| Rate for Payer: Riverside University Health System MISP |
$200.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.03
|
| Rate for Payer: United Healthcare All Other HMO |
$183.02
|
| Rate for Payer: United Healthcare HMO Rider |
$179.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$425.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.85
|
| Rate for Payer: Vantage Medical Group Senior |
$425.85
|
|
|
HC IMPL GRAFT EPIFIX 5X6 CM
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$450.90 |
| Rate for Payer: Adventist Health Commercial |
$100.20
|
| Rate for Payer: Blue Shield of California Commercial |
$387.27
|
| Rate for Payer: Blue Shield of California EPN |
$252.50
|
| Rate for Payer: Cash Price |
$275.55
|
| Rate for Payer: Central Health Plan Commercial |
$400.80
|
| Rate for Payer: Cigna of CA HMO |
$350.70
|
| Rate for Payer: Cigna of CA PPO |
$350.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.40
|
| Rate for Payer: EPIC Health Plan Senior |
$200.40
|
| Rate for Payer: Galaxy Health WC |
$425.85
|
| Rate for Payer: Global Benefits Group Commercial |
$300.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.20
|
| Rate for Payer: Multiplan Commercial |
$375.75
|
| Rate for Payer: Networks By Design Commercial |
$250.50
|
| Rate for Payer: Prime Health Services Commercial |
$425.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.03
|
| Rate for Payer: United Healthcare All Other HMO |
$183.02
|
| Rate for Payer: United Healthcare HMO Rider |
$179.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.08
|
|
|
HC IMPL GRAFT EPIFIX 5X6 CM
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$450.90 |
| Rate for Payer: Adventist Health Commercial |
$100.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$304.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$425.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.24
|
| Rate for Payer: Blue Shield of California Commercial |
$306.11
|
| Rate for Payer: Blue Shield of California EPN |
$199.90
|
| Rate for Payer: Cash Price |
$275.55
|
| Rate for Payer: Cash Price |
$275.55
|
| Rate for Payer: Central Health Plan Commercial |
$400.80
|
| Rate for Payer: Cigna of CA HMO |
$350.70
|
| Rate for Payer: Cigna of CA PPO |
$350.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$425.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.40
|
| Rate for Payer: EPIC Health Plan Senior |
$200.40
|
| Rate for Payer: Galaxy Health WC |
$425.85
|
| Rate for Payer: Global Benefits Group Commercial |
$300.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.33
|
| Rate for Payer: InnovAge PACE Commercial |
$250.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$350.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$350.70
|
| Rate for Payer: Multiplan Commercial |
$375.75
|
| Rate for Payer: Networks By Design Commercial |
$250.50
|
| Rate for Payer: Prime Health Services Commercial |
$425.85
|
| Rate for Payer: Riverside University Health System MISP |
$200.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.03
|
| Rate for Payer: United Healthcare All Other HMO |
$183.02
|
| Rate for Payer: United Healthcare HMO Rider |
$179.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$164.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$425.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.85
|
| Rate for Payer: Vantage Medical Group Senior |
$425.85
|
|
|
HC IMPL MED REVEAL LINQ LNQ11
|
Facility
|
OP
|
$12,488.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.60 |
| Max. Negotiated Rate |
$11,239.20 |
| Rate for Payer: Adventist Health Commercial |
$2,497.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,614.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,868.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,366.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,702.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,914.61
|
| Rate for Payer: Blue Shield of California Commercial |
$9,653.22
|
| Rate for Payer: Blue Shield of California EPN |
$6,293.95
|
| Rate for Payer: Cash Price |
$6,868.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,990.40
|
| Rate for Payer: Cigna of CA HMO |
$8,741.60
|
| Rate for Payer: Cigna of CA PPO |
$8,741.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,614.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,614.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,614.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,995.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,995.20
|
| Rate for Payer: Galaxy Health WC |
$10,614.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,492.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,239.20
|
| Rate for Payer: InnovAge PACE Commercial |
$6,244.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,329.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,757.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,730.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,497.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,741.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,741.60
|
| Rate for Payer: Multiplan Commercial |
$9,366.00
|
| Rate for Payer: Networks By Design Commercial |
$6,244.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,614.80
|
| Rate for Payer: Riverside University Health System MISP |
$4,995.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,492.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,492.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,686.75
|
| Rate for Payer: United Healthcare All Other HMO |
$4,561.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4,463.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,089.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,614.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,614.80
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.80
|
|
|
HC IMPL MED REVEAL LINQ LNQ11
|
Facility
|
IP
|
$12,488.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.60 |
| Max. Negotiated Rate |
$11,239.20 |
| Rate for Payer: Adventist Health Commercial |
$2,497.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9,653.22
|
| Rate for Payer: Blue Shield of California EPN |
$6,293.95
|
| Rate for Payer: Cash Price |
$6,868.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,990.40
|
| Rate for Payer: Cigna of CA HMO |
$8,741.60
|
| Rate for Payer: Cigna of CA PPO |
$8,741.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,995.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,995.20
|
| Rate for Payer: Galaxy Health WC |
$10,614.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,492.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,239.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,329.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,757.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,730.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,497.60
|
| Rate for Payer: Multiplan Commercial |
$9,366.00
|
| Rate for Payer: Networks By Design Commercial |
$6,244.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,614.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,686.75
|
| Rate for Payer: United Healthcare All Other HMO |
$4,561.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4,463.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,089.82
|
|
|
HC IMPL PRIMATRIX 4CM X 4CM MESH
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$146.10
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
|
|
HC IMPL PRIMATRIX 4CM X 4CM MESH
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$115.48
|
| Rate for Payer: Blue Shield of California EPN |
$75.41
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.41
|
| Rate for Payer: InnovAge PACE Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$132.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Riverside University Health System MISP |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC IMPL PRIMATRIX 5CM X 5CM MESH
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$141.46
|
| Rate for Payer: Blue Shield of California EPN |
$92.23
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.60
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
|
|
HC IMPL PRIMATRIX 5CM X 5CM MESH
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.48
|
| Rate for Payer: Blue Shield of California Commercial |
$111.81
|
| Rate for Payer: Blue Shield of California EPN |
$73.02
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$155.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.41
|
| Rate for Payer: InnovAge PACE Commercial |
$91.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.10
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: Riverside University Health System MISP |
$73.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.55
|
| Rate for Payer: Vantage Medical Group Senior |
$155.55
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM FENESTRATED
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.00
|
| Rate for Payer: Blue Shield of California Commercial |
$76.99
|
| Rate for Payer: Blue Shield of California EPN |
$50.27
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$88.20
|
| Rate for Payer: Cigna of CA PPO |
$88.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.41
|
| Rate for Payer: InnovAge PACE Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$63.00
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Riverside University Health System MISP |
$50.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.29
|
| Rate for Payer: United Healthcare All Other HMO |
$46.03
|
| Rate for Payer: United Healthcare HMO Rider |
$45.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.10
|
| Rate for Payer: Vantage Medical Group Senior |
$107.10
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM FENESTRATED
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California Commercial |
$97.40
|
| Rate for Payer: Blue Shield of California EPN |
$63.50
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$88.20
|
| Rate for Payer: Cigna of CA PPO |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$63.00
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.29
|
| Rate for Payer: United Healthcare All Other HMO |
$46.03
|
| Rate for Payer: United Healthcare HMO Rider |
$45.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.27
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM MESH
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.00
|
| Rate for Payer: Blue Shield of California Commercial |
$76.99
|
| Rate for Payer: Blue Shield of California EPN |
$50.27
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$88.20
|
| Rate for Payer: Cigna of CA PPO |
$88.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.41
|
| Rate for Payer: InnovAge PACE Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$63.00
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Riverside University Health System MISP |
$50.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.29
|
| Rate for Payer: United Healthcare All Other HMO |
$46.03
|
| Rate for Payer: United Healthcare HMO Rider |
$45.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.10
|
| Rate for Payer: Vantage Medical Group Senior |
$107.10
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM MESH
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California Commercial |
$97.40
|
| Rate for Payer: Blue Shield of California EPN |
$63.50
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$88.20
|
| Rate for Payer: Cigna of CA PPO |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$63.00
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.29
|
| Rate for Payer: United Healthcare All Other HMO |
$46.03
|
| Rate for Payer: United Healthcare HMO Rider |
$45.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.27
|
|
|
HC IMPL PRIMATRIX AG 4CM X 4CM FENESTRATED
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$146.10
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
|
|
HC IMPL PRIMATRIX AG 4CM X 4CM FENESTRATED
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$115.48
|
| Rate for Payer: Blue Shield of California EPN |
$75.41
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.41
|
| Rate for Payer: InnovAge PACE Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$132.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Riverside University Health System MISP |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC IMPL PRIMATRIX AG 4CM X 4CM MESH
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101522
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$115.48
|
| Rate for Payer: Blue Shield of California EPN |
$75.41
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.41
|
| Rate for Payer: InnovAge PACE Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$132.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Riverside University Health System MISP |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC IMPL PRIMATRIX AG 4CM X 4CM MESH
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101522
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$146.10
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$103.95
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
|
|
HC IMPL PRIMATRIX AG 6CM X 6CM FENESTRATED
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101523
|
|
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 |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| 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 |
$65.41
|
| 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 |
$74.21
|
| 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 PRIMATRIX AG 6CM X 6CM FENESTRATED
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101523
|
|
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 |
$73.15
|
| 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 SJM CONFIRM LOOPRE DM3500
|
Facility
|
IP
|
$11,500.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.00 |
| Max. Negotiated Rate |
$10,350.00 |
| Rate for Payer: Adventist Health Commercial |
$2,300.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,889.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,796.00
|
| Rate for Payer: Cash Price |
$6,325.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,200.00
|
| Rate for Payer: Cigna of CA HMO |
$8,050.00
|
| Rate for Payer: Cigna of CA PPO |
$8,050.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,600.00
|
| Rate for Payer: Galaxy Health WC |
$9,775.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,900.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,670.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,381.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,118.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,300.00
|
| Rate for Payer: Multiplan Commercial |
$8,625.00
|
| Rate for Payer: Networks By Design Commercial |
$5,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,775.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,315.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4,200.95
|
| Rate for Payer: United Healthcare HMO Rider |
$4,110.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,766.25
|
|
|
HC IMPL SJM CONFIRM LOOPRE DM3500
|
Facility
|
OP
|
$11,500.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,300.00 |
| Max. Negotiated Rate |
$10,350.00 |
| Rate for Payer: Adventist Health Commercial |
$2,300.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,775.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,325.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,625.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,250.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,367.55
|
| Rate for Payer: Blue Shield of California Commercial |
$8,889.50
|
| Rate for Payer: Blue Shield of California EPN |
$5,796.00
|
| Rate for Payer: Cash Price |
$6,325.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,200.00
|
| Rate for Payer: Cigna of CA HMO |
$8,050.00
|
| Rate for Payer: Cigna of CA PPO |
$8,050.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,775.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,775.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,600.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,600.00
|
| Rate for Payer: Galaxy Health WC |
$9,775.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,900.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,350.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5,750.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,670.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,381.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,118.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,300.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,050.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,050.00
|
| Rate for Payer: Multiplan Commercial |
$8,625.00
|
| Rate for Payer: Networks By Design Commercial |
$5,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,775.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,600.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,900.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,900.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,315.95
|
| Rate for Payer: United Healthcare All Other HMO |
$4,200.95
|
| Rate for Payer: United Healthcare HMO Rider |
$4,110.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,766.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,775.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,775.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,775.00
|
|
