|
HC IMPL DRSNG OASIS WND MATRIX 3X3.5CM
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101458
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Blue Shield of California Commercial |
$57.00
|
| Rate for Payer: Blue Shield of California EPN |
$40.58
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan 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: 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
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X7CM
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Blue Shield of California Commercial |
$57.00
|
| Rate for Payer: Blue Shield of California EPN |
$40.58
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan 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: 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
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X7CM
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$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
|
|
|
HC IMPL GRAFIX CORE 2 X 3 CM 6 UNITS
|
Facility
IP
|
$644.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
900101532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Blue Shield of California Commercial |
$483.00
|
| Rate for Payer: Blue Shield of California EPN |
$343.90
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| Rate for Payer: Cigna of CA HMO |
$450.80
|
| Rate for Payer: Cigna of CA PPO |
$450.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: Networks By Design Commercial |
$322.00
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
|
|
HC IMPL GRAFIX CORE 2 X 3 CM 6 UNITS
|
Facility
OP
|
$644.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
900101532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.32 |
| Max. Negotiated Rate |
$980.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$980.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$547.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$354.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$354.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.68
|
| Rate for Payer: BCBS Transplant Transplant |
$386.40
|
| Rate for Payer: Blue Shield of California Commercial |
$405.08
|
| Rate for Payer: Blue Shield of California EPN |
$314.92
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$515.20
|
| Rate for Payer: Cigna of CA HMO |
$450.80
|
| Rate for Payer: Cigna of CA PPO |
$450.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.60
|
| Rate for Payer: Galaxy Health WC |
$547.40
|
| Rate for Payer: Global Benefits Group Commercial |
$386.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$579.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$483.00
|
| Rate for Payer: IEHP medi-cal |
$97.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$429.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$483.00
|
| Rate for Payer: Networks By Design Commercial |
$322.00
|
| Rate for Payer: Prime Health Services Commercial |
$547.40
|
| Rate for Payer: Riverside University Health MISP |
$257.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$386.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$386.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.00
|
| Rate for Payer: United Healthcare All Other HMO |
$322.00
|
| Rate for Payer: United Healthcare HMO Rider |
$322.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$322.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.40
|
| Rate for Payer: Vantage Medical Group Senior |
$547.40
|
|
|
HC IMPL GRAFIX PRIME 2 X 3 CM 6 UNITS
|
Facility
IP
|
$339.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101533
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Blue Shield of California Commercial |
$254.25
|
| Rate for Payer: Blue Shield of California EPN |
$181.03
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
|
|
HC IMPL GRAFIX PRIME 2 X 3 CM 6 UNITS
|
Facility
OP
|
$339.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101533
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$844.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$844.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$186.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.68
|
| Rate for Payer: BCBS Transplant Transplant |
$203.40
|
| Rate for Payer: Blue Shield of California Commercial |
$213.23
|
| Rate for Payer: Blue Shield of California EPN |
$165.77
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$254.25
|
| Rate for Payer: IEHP medi-cal |
$141.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Riverside University Health MISP |
$135.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.50
|
| Rate for Payer: United Healthcare All Other HMO |
$169.50
|
| Rate for Payer: United Healthcare HMO Rider |
$169.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$169.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC IMPL GRAFT DERMAGRAFT 5CM X 7.5CM
|
Facility
OP
|
$133.00
|
|
|
Service Code
|
CPT Q4106
|
| Hospital Charge Code |
900101460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$278.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$278.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$73.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$73.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.11
|
| Rate for Payer: BCBS Transplant Transplant |
$79.80
|
| Rate for Payer: Blue Shield of California Commercial |
$83.66
|
| Rate for Payer: Blue Shield of California EPN |
$65.04
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$93.10
|
| Rate for Payer: Cigna of CA PPO |
$93.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$99.75
|
| Rate for Payer: IEHP medi-cal |
$46.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| 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: Riverside University Health 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 |
$66.50
|
| Rate for Payer: United Healthcare All Other HMO |
$66.50
|
| Rate for Payer: United Healthcare HMO Rider |
$66.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.05
|
| Rate for Payer: Vantage Medical Group Senior |
$113.05
|
|
|
HC IMPL GRAFT DERMAGRAFT 5CM X 7.5CM
|
Facility
IP
|
$133.00
|
|
|
Service Code
|
CPT Q4106
|
| Hospital Charge Code |
900101460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Blue Shield of California Commercial |
$99.75
|
| Rate for Payer: Blue Shield of California EPN |
$71.02
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$93.10
|
| Rate for Payer: Cigna of CA PPO |
$93.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: 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
|
|
|
HC IMPL GRAFT EPIFIX 14MM DISK
|
Facility
OP
|
$1,378.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.67 |
| Max. Negotiated Rate |
$1,240.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$939.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,171.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$757.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$757.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$667.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$814.12
|
| Rate for Payer: BCBS Transplant Transplant |
$826.80
|
| Rate for Payer: Blue Shield of California Commercial |
$866.76
|
| Rate for Payer: Blue Shield of California EPN |
$673.84
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,102.40
|
| Rate for Payer: Cigna of CA HMO |
$964.60
|
| Rate for Payer: Cigna of CA PPO |
$964.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,171.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$551.20
|
| Rate for Payer: Galaxy Health WC |
$1,171.30
|
| Rate for Payer: Global Benefits Group Commercial |
$826.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,240.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,033.50
|
| Rate for Payer: IEHP medi-cal |
$154.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.60
|
| Rate for Payer: Multiplan Commercial |
$1,033.50
|
| Rate for Payer: Networks By Design Commercial |
$689.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,171.30
|
| Rate for Payer: Riverside University Health MISP |
$551.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$826.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$826.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$689.00
|
| Rate for Payer: United Healthcare All Other HMO |
$689.00
|
| Rate for Payer: United Healthcare HMO Rider |
$689.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$689.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,171.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,171.30
|
|
|
HC IMPL GRAFT EPIFIX 14MM DISK
|
Facility
IP
|
$1,378.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$1,240.20 |
| Rate for Payer: Blue Shield of California Commercial |
$1,033.50
|
| Rate for Payer: Blue Shield of California EPN |
$735.85
|
| Rate for Payer: Cash Price |
$620.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,102.40
|
| Rate for Payer: Cigna of CA HMO |
$964.60
|
| Rate for Payer: Cigna of CA PPO |
$964.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$551.20
|
| Rate for Payer: Galaxy Health WC |
$1,171.30
|
| Rate for Payer: Global Benefits Group Commercial |
$826.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,240.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.60
|
| Rate for Payer: Multiplan Commercial |
$1,033.50
|
| Rate for Payer: Networks By Design Commercial |
$689.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,171.30
|
|
|
HC IMPL GRAFT EPIFIX 18MM DISK
|
Facility
IP
|
$2,673.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$534.60 |
| Max. Negotiated Rate |
$2,405.70 |
| Rate for Payer: Blue Shield of California Commercial |
$2,004.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,427.38
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,138.40
|
| Rate for Payer: Cigna of CA HMO |
$1,871.10
|
| Rate for Payer: Cigna of CA PPO |
$1,871.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,069.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,069.20
|
| Rate for Payer: Galaxy Health WC |
$2,272.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,603.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,405.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,782.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.60
|
| Rate for Payer: Multiplan Commercial |
$2,004.75
|
| Rate for Payer: Networks By Design Commercial |
$1,336.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,272.05
|
|
|
HC IMPL GRAFT EPIFIX 18MM DISK
|
Facility
OP
|
$2,673.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.67 |
| Max. Negotiated Rate |
$2,405.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$939.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,272.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,470.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,470.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,294.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,579.21
|
| Rate for Payer: BCBS Transplant Transplant |
$1,603.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,681.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,307.10
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Cash Price |
$1,202.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,138.40
|
| Rate for Payer: Cigna of CA HMO |
$1,871.10
|
| Rate for Payer: Cigna of CA PPO |
$1,871.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,272.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,069.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,069.20
|
| Rate for Payer: Galaxy Health WC |
$2,272.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,603.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,405.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,004.75
|
| Rate for Payer: IEHP medi-cal |
$154.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,782.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.60
|
| Rate for Payer: Multiplan Commercial |
$2,004.75
|
| Rate for Payer: Networks By Design Commercial |
$1,336.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,272.05
|
| Rate for Payer: Riverside University Health MISP |
$1,069.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,603.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,603.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,336.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,336.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,336.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,336.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,272.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,272.05
|
|
|
HC IMPL GRAFT EPIFIX 2X2 CM
|
Facility
OP
|
$961.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.67 |
| Max. Negotiated Rate |
$939.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$939.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$816.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$528.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$465.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$567.76
|
| Rate for Payer: BCBS Transplant Transplant |
$576.60
|
| Rate for Payer: Blue Shield of California Commercial |
$604.47
|
| Rate for Payer: Blue Shield of California EPN |
$469.93
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: Cigna of CA HMO |
$672.70
|
| Rate for Payer: Cigna of CA PPO |
$672.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$816.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$384.40
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$720.75
|
| Rate for Payer: IEHP medi-cal |
$154.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Networks By Design Commercial |
$480.50
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
| Rate for Payer: Riverside University Health MISP |
$384.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$576.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$576.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$480.50
|
| Rate for Payer: United Healthcare All Other HMO |
$480.50
|
| Rate for Payer: United Healthcare HMO Rider |
$480.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$816.85
|
| Rate for Payer: Vantage Medical Group Senior |
$816.85
|
|
|
HC IMPL GRAFT EPIFIX 2X2 CM
|
Facility
IP
|
$961.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.20 |
| Max. Negotiated Rate |
$864.90 |
| Rate for Payer: Blue Shield of California Commercial |
$720.75
|
| Rate for Payer: Blue Shield of California EPN |
$513.17
|
| Rate for Payer: Cash Price |
$432.45
|
| Rate for Payer: Central Health Plan Commercial |
$768.80
|
| Rate for Payer: Cigna of CA HMO |
$672.70
|
| Rate for Payer: Cigna of CA PPO |
$672.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$384.40
|
| Rate for Payer: Galaxy Health WC |
$816.85
|
| Rate for Payer: Global Benefits Group Commercial |
$576.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$640.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.20
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: Networks By Design Commercial |
$480.50
|
| Rate for Payer: Prime Health Services Commercial |
$816.85
|
|
|
HC IMPL GRAFT EPIFIX 2X4 CM
|
Facility
OP
|
$488.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$939.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$939.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$414.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$268.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$268.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.31
|
| Rate for Payer: BCBS Transplant Transplant |
$292.80
|
| Rate for Payer: Blue Shield of California Commercial |
$306.95
|
| Rate for Payer: Blue Shield of California EPN |
$238.63
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Central Health Plan Commercial |
$390.40
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$366.00
|
| Rate for Payer: IEHP medi-cal |
$154.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.60
|
| Rate for Payer: Multiplan Commercial |
$366.00
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
| Rate for Payer: Riverside University Health MISP |
$195.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.00
|
| Rate for Payer: United Healthcare All Other HMO |
$244.00
|
| Rate for Payer: United Healthcare HMO Rider |
$244.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.80
|
| Rate for Payer: Vantage Medical Group Senior |
$414.80
|
|
|
HC IMPL GRAFT EPIFIX 2X4 CM
|
Facility
IP
|
$488.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Blue Shield of California Commercial |
$366.00
|
| Rate for Payer: Blue Shield of California EPN |
$260.59
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Central Health Plan Commercial |
$390.40
|
| Rate for Payer: Cigna of CA HMO |
$341.60
|
| Rate for Payer: Cigna of CA PPO |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.20
|
| Rate for Payer: Galaxy Health WC |
$414.80
|
| Rate for Payer: Global Benefits Group Commercial |
$292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.60
|
| Rate for Payer: Multiplan Commercial |
$366.00
|
| Rate for Payer: Networks By Design Commercial |
$244.00
|
| Rate for Payer: Prime Health Services Commercial |
$414.80
|
|
|
HC IMPL GRAFT EPIFIX 3X4 CM
|
Facility
IP
|
$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: Blue Shield of California Commercial |
$550.50
|
| Rate for Payer: Blue Shield of California EPN |
$391.96
|
| Rate for Payer: Cash Price |
$330.30
|
| 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: EPIC Health Plan Commercial |
$293.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Kaiser Permanente of CA Commercial/Self Funded |
$489.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.80
|
| 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
|
|
|
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 |
$939.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$939.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$623.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$403.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$403.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$355.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.65
|
| Rate for Payer: BCBS Transplant Transplant |
$440.40
|
| Rate for Payer: Blue Shield of California Commercial |
$461.69
|
| Rate for Payer: Blue Shield of California EPN |
$358.93
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| 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: EPIC Health Plan Commercial |
$293.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$550.50
|
| Rate for Payer: IEHP medi-cal |
$154.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$489.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.80
|
| 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 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 |
$367.00
|
| Rate for Payer: United Healthcare All Other HMO |
$367.00
|
| Rate for Payer: United Healthcare HMO Rider |
$367.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.00
|
| 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
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: Blue Shield of California Commercial |
$162.75
|
| Rate for Payer: Blue Shield of California EPN |
$115.88
|
| Rate for Payer: Cash Price |
$97.65
|
| 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 Transplant |
$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: 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
|
|
|
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 |
$939.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$939.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$119.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.20
|
| Rate for Payer: BCBS Transplant Transplant |
$130.20
|
| Rate for Payer: Blue Shield of California Commercial |
$136.49
|
| Rate for Payer: Blue Shield of California EPN |
$106.11
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| 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: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$162.75
|
| Rate for Payer: IEHP medi-cal |
$154.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| 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: Riverside University Health 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 |
$108.50
|
| Rate for Payer: United Healthcare All Other HMO |
$108.50
|
| Rate for Payer: United Healthcare HMO Rider |
$108.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
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: Blue Shield of California Commercial |
$375.75
|
| Rate for Payer: Blue Shield of California EPN |
$267.53
|
| Rate for Payer: Cash Price |
$225.45
|
| 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 Transplant |
$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: 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
|
|
|
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 |
$939.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$939.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$425.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$275.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$295.99
|
| Rate for Payer: BCBS Transplant Transplant |
$300.60
|
| Rate for Payer: Blue Shield of California Commercial |
$315.13
|
| Rate for Payer: Blue Shield of California EPN |
$244.99
|
| Rate for Payer: Cash Price |
$225.45
|
| Rate for Payer: Cash Price |
$225.45
|
| 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: EPIC Health Plan Commercial |
$200.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$375.75
|
| Rate for Payer: IEHP medi-cal |
$154.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.17
|
| 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: Riverside University Health 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 |
$250.50
|
| Rate for Payer: United Healthcare All Other HMO |
$250.50
|
| Rate for Payer: United Healthcare HMO Rider |
$250.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.50
|
| 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: Blue Shield of California Commercial |
$375.75
|
| Rate for Payer: Blue Shield of California EPN |
$267.53
|
| Rate for Payer: Cash Price |
$225.45
|
| 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 Transplant |
$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: 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
|
|
|
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 |
$939.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$939.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$425.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$275.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$295.99
|
| Rate for Payer: BCBS Transplant Transplant |
$300.60
|
| Rate for Payer: Blue Shield of California Commercial |
$315.13
|
| Rate for Payer: Blue Shield of California EPN |
$244.99
|
| Rate for Payer: Cash Price |
$225.45
|
| Rate for Payer: Cash Price |
$225.45
|
| 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: EPIC Health Plan Commercial |
$200.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$375.75
|
| Rate for Payer: IEHP medi-cal |
$154.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.17
|
| 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: Riverside University Health 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 |
$250.50
|
| Rate for Payer: United Healthcare All Other HMO |
$250.50
|
| Rate for Payer: United Healthcare HMO Rider |
$250.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.85
|
| Rate for Payer: Vantage Medical Group Senior |
$425.85
|
|
