|
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: Blue Shield of California Commercial |
$141.75
|
| Rate for Payer: Blue Shield of California EPN |
$100.93
|
| Rate for Payer: Cash Price |
$85.05
|
| 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 Transplant |
$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: 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 |
$71.37
|
| Rate for Payer: United Healthcare All Other HMO |
$69.70
|
| Rate for Payer: United Healthcare HMO Rider |
$68.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.37
|
|
|
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 |
$242.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242.05
|
| 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 |
$103.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.84
|
| Rate for Payer: Blue Distinction Transplant |
$113.40
|
| Rate for Payer: Blue Shield of California Commercial |
$118.88
|
| Rate for Payer: Blue Shield of California EPN |
$92.42
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| 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 Media |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$141.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.13
|
| 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: 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 |
$94.50
|
| Rate for Payer: United Healthcare All Other HMO |
$94.50
|
| Rate for Payer: United Healthcare HMO Rider |
$94.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.50
|
| 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: Blue Shield of California Commercial |
$137.25
|
| Rate for Payer: Blue Shield of California EPN |
$97.72
|
| Rate for Payer: Cash Price |
$82.35
|
| 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 Transplant |
$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: 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 |
$69.10
|
| Rate for Payer: United Healthcare All Other HMO |
$67.49
|
| Rate for Payer: United Healthcare HMO Rider |
$66.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.39
|
|
|
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 |
$242.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242.05
|
| 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 |
$100.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.84
|
| Rate for Payer: Blue Distinction Transplant |
$109.80
|
| Rate for Payer: Blue Shield of California Commercial |
$115.11
|
| Rate for Payer: Blue Shield of California EPN |
$89.49
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cash Price |
$82.35
|
| 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 Media |
$155.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$137.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.13
|
| 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: 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 |
$91.50
|
| Rate for Payer: United Healthcare All Other HMO |
$91.50
|
| Rate for Payer: United Healthcare HMO Rider |
$91.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.50
|
| 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 |
$242.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242.05
|
| 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 |
$69.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.84
|
| Rate for Payer: Blue Distinction Transplant |
$75.60
|
| Rate for Payer: Blue Shield of California Commercial |
$79.25
|
| Rate for Payer: Blue Shield of California EPN |
$61.61
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| 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 Media |
$107.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$94.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.13
|
| 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: 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 |
$63.00
|
| Rate for Payer: United Healthcare All Other HMO |
$63.00
|
| Rate for Payer: United Healthcare HMO Rider |
$63.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.00
|
| 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: Blue Shield of California Commercial |
$94.50
|
| Rate for Payer: Blue Shield of California EPN |
$67.28
|
| Rate for Payer: Cash Price |
$56.70
|
| 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 Transplant |
$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: 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 |
$47.58
|
| Rate for Payer: United Healthcare All Other HMO |
$46.47
|
| Rate for Payer: United Healthcare HMO Rider |
$45.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.58
|
|
|
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: Blue Shield of California Commercial |
$94.50
|
| Rate for Payer: Blue Shield of California EPN |
$67.28
|
| Rate for Payer: Cash Price |
$56.70
|
| 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 Transplant |
$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: 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 |
$47.58
|
| Rate for Payer: United Healthcare All Other HMO |
$46.47
|
| Rate for Payer: United Healthcare HMO Rider |
$45.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.58
|
|
|
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 |
$242.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242.05
|
| 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 |
$69.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.84
|
| Rate for Payer: Blue Distinction Transplant |
$75.60
|
| Rate for Payer: Blue Shield of California Commercial |
$79.25
|
| Rate for Payer: Blue Shield of California EPN |
$61.61
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| 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 Media |
$107.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$94.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.13
|
| 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: 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 |
$63.00
|
| Rate for Payer: United Healthcare All Other HMO |
$63.00
|
| Rate for Payer: United Healthcare HMO Rider |
$63.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.10
|
| Rate for Payer: Vantage Medical Group Senior |
$107.10
|
|
|
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 |
$242.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242.05
|
| 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 |
$103.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.84
|
| Rate for Payer: Blue Distinction Transplant |
$113.40
|
| Rate for Payer: Blue Shield of California Commercial |
$118.88
|
| Rate for Payer: Blue Shield of California EPN |
$92.42
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| 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 Media |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$141.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.13
|
| 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: 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 |
$94.50
|
| Rate for Payer: United Healthcare All Other HMO |
$94.50
|
| Rate for Payer: United Healthcare HMO Rider |
$94.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.50
|
| 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 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: Blue Shield of California Commercial |
$141.75
|
| Rate for Payer: Blue Shield of California EPN |
$100.93
|
| Rate for Payer: Cash Price |
$85.05
|
| 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 Transplant |
$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: 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 |
$71.37
|
| Rate for Payer: United Healthcare All Other HMO |
$69.70
|
| Rate for Payer: United Healthcare HMO Rider |
$68.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.37
|
|
|
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: Blue Shield of California Commercial |
$141.75
|
| Rate for Payer: Blue Shield of California EPN |
$100.93
|
| Rate for Payer: Cash Price |
$85.05
|
| 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 Transplant |
$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: 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 |
$71.37
|
| Rate for Payer: United Healthcare All Other HMO |
$69.70
|
| Rate for Payer: United Healthcare HMO Rider |
$68.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.37
|
|
|
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 |
$242.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242.05
|
| 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 |
$103.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.84
|
| Rate for Payer: Blue Distinction Transplant |
$113.40
|
| Rate for Payer: Blue Shield of California Commercial |
$118.88
|
| Rate for Payer: Blue Shield of California EPN |
$92.42
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| 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 Media |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$141.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.13
|
| 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: 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 |
$94.50
|
| Rate for Payer: United Healthcare All Other HMO |
$94.50
|
| Rate for Payer: United Healthcare HMO Rider |
$94.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
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 |
$242.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$242.05
|
| 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 |
$73.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.84
|
| Rate for Payer: Blue Distinction 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: Dignity Health Media |
$113.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$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) Other |
$99.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.13
|
| 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 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 |
$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 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: 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: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| 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 |
$50.22
|
| Rate for Payer: United Healthcare All Other HMO |
$49.05
|
| Rate for Payer: United Healthcare HMO Rider |
$47.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.89
|
|
|
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: Blue Shield of California EPN |
$6,141.00
|
| Rate for Payer: Cash Price |
$5,175.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$2,300.00
|
| Rate for Payer: Multiplan Commercial |
$8,625.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,775.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,342.40
|
| Rate for Payer: United Healthcare All Other HMO |
$4,241.20
|
| Rate for Payer: United Healthcare HMO Rider |
$4,149.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,795.00
|
|
|
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: 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 |
$6,325.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,250.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,405.50
|
| Rate for Payer: Blue Distinction Transplant |
$6,900.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,625.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,256.00
|
| Rate for Payer: Cash Price |
$5,175.00
|
| 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 Media |
$9,775.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,775.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,600.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$8,625.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,025.00
|
| 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: 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: 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 |
$5,750.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,750.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,750.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,750.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,775.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,775.00
|
|
|
HC IMPL SPINAL CANAL CATH
|
Facility
|
OP
|
$16,907.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
900100865
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$495.86 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,323.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$11,378.77
|
| Rate for Payer: Blue Distinction Transplant |
$10,144.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$8,323.04
|
| Rate for Payer: Cash Price |
$7,608.15
|
| Rate for Payer: Cash Price |
$7,608.15
|
| Rate for Payer: Central Health Plan Commercial |
$13,525.60
|
| Rate for Payer: Cigna of CA PPO |
$12,511.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Media |
$8,323.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,236.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,323.04
|
| Rate for Payer: Galaxy Health WC |
$14,370.95
|
| Rate for Payer: Global Benefits Group Commercial |
$10,144.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,216.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,680.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,649.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,733.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,323.04
|
| Rate for Payer: InnovAge PACE Commercial |
$12,484.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,276.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,323.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,381.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,152.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,152.87
|
| Rate for Payer: Multiplan Commercial |
$12,680.25
|
| Rate for Payer: Multiplan WC |
$11,378.77
|
| Rate for Payer: Networks By Design Commercial |
$10,989.55
|
| Rate for Payer: Preferred Health Network WC |
$11,610.99
|
| Rate for Payer: Prime Health Services Commercial |
$14,370.95
|
| Rate for Payer: Prime Health Services Medicare |
$8,822.42
|
| Rate for Payer: Prime Health Services WC |
$11,262.66
|
| Rate for Payer: Riverside University Health System MISP |
$9,155.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,144.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
HC IMPL SPINAL CANAL CATH
|
Facility
|
IP
|
$16,907.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
900100865
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,381.40 |
| Max. Negotiated Rate |
$15,216.30 |
| Rate for Payer: Cash Price |
$7,608.15
|
| Rate for Payer: Central Health Plan Commercial |
$13,525.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,762.80
|
| Rate for Payer: Galaxy Health WC |
$14,370.95
|
| Rate for Payer: Global Benefits Group Commercial |
$10,144.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,216.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,276.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,441.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,381.40
|
| Rate for Payer: Multiplan Commercial |
$12,680.25
|
| Rate for Payer: Networks By Design Commercial |
$10,989.55
|
| Rate for Payer: Prime Health Services Commercial |
$14,370.95
|
|
|
HC IMPROVE RESP FX - 15 MIN
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT G0238
|
| Hospital Charge Code |
900201803
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Central Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.60
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$372.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: Networks By Design Commercial |
$269.10
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
|
|
HC IMPROVE RESP FX - 15 MIN
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT G0238
|
| Hospital Charge Code |
900201803
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$248.40
|
| Rate for Payer: Blue Shield of California Commercial |
$260.41
|
| Rate for Payer: Blue Shield of California EPN |
$202.45
|
| Rate for Payer: Caremore Medicare Advantage |
$37.20
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Central Health Plan Commercial |
$331.20
|
| Rate for Payer: Cigna of CA HMO |
$264.96
|
| Rate for Payer: Cigna of CA PPO |
$306.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Media |
$37.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$372.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$310.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: InnovAge PACE Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: Networks By Design Commercial |
$269.10
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$248.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$248.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
|
IP
|
$2,751.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$550.20 |
| Max. Negotiated Rate |
$2,475.90 |
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,200.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,100.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,100.40
|
| Rate for Payer: Galaxy Health WC |
$2,338.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,650.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,475.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,834.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,048.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.20
|
| Rate for Payer: Multiplan Commercial |
$2,063.25
|
| Rate for Payer: Networks By Design Commercial |
$1,788.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,338.35
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
|
OP
|
$2,751.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$550.20 |
| Max. Negotiated Rate |
$4,230.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$735.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,256.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,468.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,230.49
|
| Rate for Payer: Blue Distinction Transplant |
$1,650.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,700.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,336.99
|
| Rate for Payer: Caremore Medicare Advantage |
$735.49
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Cash Price |
$1,237.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,200.80
|
| Rate for Payer: Cigna of CA HMO |
$1,760.64
|
| Rate for Payer: Cigna of CA PPO |
$2,035.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Dignity Health Media |
$735.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$735.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$735.49
|
| Rate for Payer: Galaxy Health WC |
$2,338.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,650.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,475.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,063.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,206.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,213.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.49
|
| Rate for Payer: InnovAge PACE Commercial |
$1,103.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,834.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$985.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$985.56
|
| Rate for Payer: Multiplan Commercial |
$2,063.25
|
| Rate for Payer: Networks By Design Commercial |
$1,788.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,338.35
|
| Rate for Payer: Prime Health Services Medicare |
$779.62
|
| Rate for Payer: Riverside University Health System MISP |
$809.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,650.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Vantage Medical Group Senior |
$735.49
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
|
IP
|
$2,614.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$522.80 |
| Max. Negotiated Rate |
$2,352.60 |
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,091.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,045.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,045.60
|
| Rate for Payer: Galaxy Health WC |
$2,221.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,568.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,352.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,743.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$995.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.80
|
| Rate for Payer: Multiplan Commercial |
$1,960.50
|
| Rate for Payer: Networks By Design Commercial |
$1,699.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,221.90
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
|
OP
|
$2,614.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$522.80 |
| Max. Negotiated Rate |
$3,524.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$735.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,252.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,889.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,524.72
|
| Rate for Payer: Blue Distinction Transplant |
$1,568.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,615.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,270.40
|
| Rate for Payer: Caremore Medicare Advantage |
$735.49
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,091.20
|
| Rate for Payer: Cigna of CA HMO |
$1,672.96
|
| Rate for Payer: Cigna of CA PPO |
$1,934.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Dignity Health Media |
$735.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$735.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$735.49
|
| Rate for Payer: Galaxy Health WC |
$2,221.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,568.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,352.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,960.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,206.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,213.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.49
|
| Rate for Payer: InnovAge PACE Commercial |
$1,103.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,743.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$985.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$985.56
|
| Rate for Payer: Multiplan Commercial |
$1,960.50
|
| Rate for Payer: Networks By Design Commercial |
$1,699.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,221.90
|
| Rate for Payer: Prime Health Services Medicare |
$779.62
|
| Rate for Payer: Riverside University Health System MISP |
$809.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,568.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Vantage Medical Group Senior |
$735.49
|
|
|
HC IN111 PENTETRTID/OCTRE/LT 6MCI
|
Facility
|
IP
|
$19,095.00
|
|
|
Service Code
|
CPT A9572
|
| Hospital Charge Code |
909301570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,819.00 |
| Max. Negotiated Rate |
$17,185.50 |
| Rate for Payer: Blue Shield of California Commercial |
$14,321.25
|
| Rate for Payer: Blue Shield of California EPN |
$10,196.73
|
| Rate for Payer: Cash Price |
$8,592.75
|
| Rate for Payer: Central Health Plan Commercial |
$15,276.00
|
| Rate for Payer: Cigna of CA HMO |
$13,366.50
|
| Rate for Payer: Cigna of CA PPO |
$13,366.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,638.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,638.00
|
| Rate for Payer: Galaxy Health WC |
$16,230.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11,457.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,185.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,736.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,275.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,819.00
|
| Rate for Payer: Multiplan Commercial |
$14,321.25
|
| Rate for Payer: Networks By Design Commercial |
$9,547.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,230.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,210.27
|
| Rate for Payer: United Healthcare All Other HMO |
$7,042.24
|
| Rate for Payer: United Healthcare HMO Rider |
$6,889.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,301.35
|
|
