|
HC IMMUNOTYPING ELECTROPHORESIS
|
Facility
IP
|
$255.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Central Health Plan Commercial |
$204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.00
|
| Rate for Payer: Galaxy Health WC |
$216.75
|
| Rate for Payer: Global Benefits Group Commercial |
$153.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.00
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| Rate for Payer: Networks By Design Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Commercial |
$216.75
|
|
|
HC IMMUNOTYPING ELECTROPHORESIS
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$198.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$22.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.22
|
| Rate for Payer: BCBS Transplant Transplant |
$51.00
|
| Rate for Payer: Blue Shield of California Commercial |
$52.53
|
| Rate for Payer: Blue Shield of California EPN |
$41.31
|
| Rate for Payer: Caremore Medicare Advantage |
$22.34
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.34
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$63.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.64
|
| Rate for Payer: IEHP medi-cal |
$36.86
|
| Rate for Payer: IEHP Medicare Advantage |
$22.34
|
| Rate for Payer: Innovage PACE Commercial |
$33.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.94
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Prime Health Services Medicare |
$23.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: Riverside University Health MISP |
$24.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.10
|
| Rate for Payer: United Healthcare All Other HMO |
$18.10
|
| Rate for Payer: United Healthcare HMO Rider |
$18.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
|
|
HC IMPEDANCE TESTING
|
Facility
OP
|
$332.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$50.11 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$199.20
|
| Rate for Payer: Blue Shield of California Commercial |
$208.83
|
| Rate for Payer: Blue Shield of California EPN |
$162.35
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: Cigna of CA HMO |
$212.48
|
| Rate for Payer: Cigna of CA PPO |
$245.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$249.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: IEHP medi-cal |
$82.68
|
| Rate for Payer: IEHP Medicare Advantage |
$50.11
|
| Rate for Payer: Innovage PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$199.20
|
| Rate for Payer: Riverside University Health MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.00
|
| Rate for Payer: United Healthcare All Other HMO |
$166.00
|
| Rate for Payer: United Healthcare HMO Rider |
$166.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC IMPEDANCE TESTING
|
Facility
OP
|
$332.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.11 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$196.15
|
| Rate for Payer: BCBS Transplant Transplant |
$199.20
|
| Rate for Payer: Blue Shield of California Commercial |
$208.83
|
| Rate for Payer: Blue Shield of California EPN |
$162.35
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: Cigna of CA HMO |
$212.48
|
| Rate for Payer: Cigna of CA PPO |
$245.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$249.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: IEHP medi-cal |
$82.68
|
| Rate for Payer: IEHP Medicare Advantage |
$50.11
|
| Rate for Payer: Innovage PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$199.20
|
| Rate for Payer: Riverside University Health MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.00
|
| Rate for Payer: United Healthcare All Other HMO |
$166.00
|
| Rate for Payer: United Healthcare HMO Rider |
$166.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC IMPEDANCE TESTING
|
Facility
IP
|
$332.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC IMPEDANCE TESTING
|
Facility
IP
|
$332.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
IP
|
$15,029.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,005.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$6,763.05
|
| Rate for Payer: Cash Price |
$6,763.05
|
| Rate for Payer: Central Health Plan Commercial |
$12,023.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,011.60
|
| Rate for Payer: Galaxy Health WC |
$12,774.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,017.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,526.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,024.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,005.80
|
| Rate for Payer: Multiplan Commercial |
$11,271.75
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,774.65
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
OP
|
$15,029.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,257.00 |
| Max. Negotiated Rate |
$13,979.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,283.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,774.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,265.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,265.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: BCBS Transplant Transplant |
$9,017.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,958.72
|
| Rate for Payer: Blue Shield of California EPN |
$6,434.55
|
| Rate for Payer: Cash Price |
$6,763.05
|
| Rate for Payer: Cash Price |
$6,763.05
|
| Rate for Payer: Central Health Plan Commercial |
$12,023.20
|
| Rate for Payer: Cigna of CA PPO |
$11,121.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,774.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,011.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,011.60
|
| Rate for Payer: Galaxy Health WC |
$12,774.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,017.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,526.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,271.75
|
| Rate for Payer: IEHP medi-cal |
$5,260.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,024.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,005.80
|
| Rate for Payer: Multiplan Commercial |
$11,271.75
|
| Rate for Payer: Networks By Design Commercial |
$9,768.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,774.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,017.40
|
| Rate for Payer: Riverside University Health MISP |
$6,011.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,017.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,774.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12,774.65
|
|
|
HC IMPLANTABLE PORT FOR MEDS
|
Facility
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Blue Shield of California EPN |
$865.08
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
|
|
HC IMPLANTABLE PORT FOR MEDS
|
Facility
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1788
|
| Hospital Charge Code |
909081100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$3,733.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,733.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$891.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$902.34
|
| Rate for Payer: BCBS Transplant Transplant |
$972.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,215.00
|
| Rate for Payer: Blue Shield of California EPN |
$881.28
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,215.00
|
| Rate for Payer: IEHP medi-cal |
$567.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Riverside University Health MISP |
$648.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$810.00
|
| Rate for Payer: United Healthcare All Other HMO |
$810.00
|
| Rate for Payer: United Healthcare HMO Rider |
$810.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$810.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC IMPLANTED GRID/DEPTH
|
Facility
IP
|
$1,830.00
|
|
| Hospital Charge Code |
900600801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: Blue Shield of California EPN |
$977.22
|
| Rate for Payer: Cash Price |
$823.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,464.00
|
| Rate for Payer: Cigna of CA HMO |
$1,281.00
|
| Rate for Payer: Cigna of CA PPO |
$1,281.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$732.00
|
| Rate for Payer: Galaxy Health WC |
$1,555.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,098.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,647.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,220.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.00
|
| Rate for Payer: Multiplan Commercial |
$1,372.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,555.50
|
|
|
HC IMPLANTED GRID/DEPTH
|
Facility
OP
|
$1,830.00
|
|
| Hospital Charge Code |
900600801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,555.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,006.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,006.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$835.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,019.31
|
| Rate for Payer: BCBS Transplant Transplant |
$1,098.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,372.50
|
| Rate for Payer: Blue Shield of California EPN |
$995.52
|
| Rate for Payer: Cash Price |
$823.50
|
| Rate for Payer: Cash Price |
$823.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,464.00
|
| Rate for Payer: Cigna of CA HMO |
$1,281.00
|
| Rate for Payer: Cigna of CA PPO |
$1,281.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,555.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$732.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$732.00
|
| Rate for Payer: Galaxy Health WC |
$1,555.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,098.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,647.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,372.50
|
| Rate for Payer: IEHP medi-cal |
$640.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,220.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.00
|
| Rate for Payer: Multiplan Commercial |
$1,372.50
|
| Rate for Payer: Networks By Design Commercial |
$915.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,555.50
|
| Rate for Payer: Riverside University Health MISP |
$732.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,098.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,098.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$915.00
|
| Rate for Payer: United Healthcare All Other HMO |
$915.00
|
| Rate for Payer: United Healthcare HMO Rider |
$915.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$915.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,555.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,555.50
|
|
|
HC IMPLANTED PERIONEAL PORT
|
Facility
OP
|
$21,819.00
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
909001457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,363.80 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$13,091.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$9,818.55
|
| Rate for Payer: Cash Price |
$9,818.55
|
| Rate for Payer: Central Health Plan Commercial |
$17,455.20
|
| Rate for Payer: Cigna of CA PPO |
$16,146.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$18,546.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,091.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,637.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16,364.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: IEHP medi-cal |
$11,329.02
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Innovage PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,553.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,363.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$16,364.25
|
| Rate for Payer: Networks By Design Commercial |
$14,182.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,546.15
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13,091.40
|
| Rate for Payer: Riverside University Health MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,091.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC IMPLANTED PERIONEAL PORT
|
Facility
IP
|
$21,819.00
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
909001457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,363.80 |
| Max. Negotiated Rate |
$19,637.10 |
| Rate for Payer: Cash Price |
$9,818.55
|
| Rate for Payer: Central Health Plan Commercial |
$17,455.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,727.60
|
| Rate for Payer: Galaxy Health WC |
$18,546.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,091.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,637.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,553.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,363.80
|
| Rate for Payer: Multiplan Commercial |
$16,364.25
|
| Rate for Payer: Networks By Design Commercial |
$14,182.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,546.15
|
|
|
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 |
$236.78 |
| Max. Negotiated Rate |
$4,050.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$236.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,825.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,475.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,475.55
|
| Rate for Payer: BCBS Transplant Transplant |
$2,700.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,831.13
|
| Rate for Payer: Blue Shield of California EPN |
$2,200.99
|
| Rate for Payer: Cash Price |
$2,025.45
|
| 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: EPIC Health Plan Commercial |
$1,800.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$3,375.75
|
| Rate for Payer: IEHP medi-cal |
$1,575.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.17
|
| 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: Riverside University Health 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 |
$2,250.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,250.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,250.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,250.50
|
| 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 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: Blue Shield of California Commercial |
$3,375.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,403.53
|
| 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 Transplant |
$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: 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
|
|
|
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: Blue Shield of California Commercial |
$2,632.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,874.34
|
| 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 Transplant |
$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: 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
|
|
|
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 |
$236.78 |
| Max. Negotiated Rate |
$3,159.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$236.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,930.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,930.50
|
| Rate for Payer: BCBS Transplant Transplant |
$2,106.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,207.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,716.39
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,808.00
|
| Rate for Payer: Cigna of CA HMO |
$2,457.00
|
| Rate for Payer: Cigna of CA PPO |
$2,457.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,983.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,632.50
|
| Rate for Payer: IEHP medi-cal |
$1,228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| 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: Riverside University Health 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 |
$1,755.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,755.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,755.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,983.50
|
|
|
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 |
$236.78 |
| Max. Negotiated Rate |
$10,714.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$236.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,119.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,547.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,547.75
|
| Rate for Payer: BCBS Transplant Transplant |
$7,143.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,488.24
|
| Rate for Payer: Blue Shield of California EPN |
$5,821.54
|
| Rate for Payer: Cash Price |
$5,357.25
|
| Rate for Payer: Cash Price |
$5,357.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,524.00
|
| Rate for Payer: Cigna of CA HMO |
$8,333.50
|
| Rate for Payer: Cigna of CA PPO |
$8,333.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,119.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,762.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$8,928.75
|
| Rate for Payer: IEHP medi-cal |
$4,166.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,940.64
|
| 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: Riverside University Health 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 |
$5,952.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,952.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,952.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,952.50
|
| 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 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: Blue Shield of California Commercial |
$8,928.75
|
| Rate for Payer: Blue Shield of California EPN |
$6,357.27
|
| 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 Transplant |
$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: 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
|
|
|
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 |
$236.78 |
| Max. Negotiated Rate |
$2,369.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$236.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,238.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,448.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,448.15
|
| Rate for Payer: BCBS Transplant Transplant |
$1,579.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,656.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,287.54
|
| Rate for Payer: Cash Price |
$1,184.85
|
| Rate for Payer: Cash Price |
$1,184.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,106.40
|
| Rate for Payer: Cigna of CA HMO |
$1,843.10
|
| Rate for Payer: Cigna of CA PPO |
$1,843.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,238.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,053.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$1,974.75
|
| Rate for Payer: IEHP medi-cal |
$921.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,756.21
|
| 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: Riverside University Health 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 |
$1,316.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,316.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,316.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,316.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,238.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,238.05
|
|
|
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: Blue Shield of California Commercial |
$1,974.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,406.02
|
| 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 Transplant |
$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: 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
|
|
|
HC IMPL DRESSING WOUND 5X7CM OASIS ULTRA
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT Q4124
|
| Hospital Charge Code |
900101468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.35
|
| Rate for Payer: BCBS Transplant Transplant |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$56.61
|
| Rate for Payer: Blue Shield of California EPN |
$44.01
|
| 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: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$67.50
|
| Rate for Payer: IEHP medi-cal |
$7.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| 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: Riverside University Health 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 |
$45.00
|
| Rate for Payer: United Healthcare All Other HMO |
$45.00
|
| Rate for Payer: United Healthcare HMO Rider |
$45.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.00
|
| 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: Blue Shield of California Commercial |
$67.50
|
| Rate for Payer: Blue Shield of California EPN |
$48.06
|
| 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 Transplant |
$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: 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
|
|
|
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 |
$5.77 |
| Max. Negotiated Rate |
$83.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$83.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.32
|
| Rate for Payer: BCBS Transplant Transplant |
$45.60
|
| Rate for Payer: Blue Shield of California Commercial |
$47.80
|
| Rate for Payer: Blue Shield of California EPN |
$37.16
|
| 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: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$57.00
|
| Rate for Payer: IEHP medi-cal |
$11.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| 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: Riverside University Health 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 |
$38.00
|
| Rate for Payer: United Healthcare All Other HMO |
$38.00
|
| Rate for Payer: United Healthcare HMO Rider |
$38.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
