|
HC WORK HARDENING INITIAL 2HR OT
|
Facility
OP
|
$142.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
903207545
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$519.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$519.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$78.10
|
| 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: BCBS Transplant Transplant |
$85.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$106.50
|
| Rate for Payer: IEHP medi-cal |
$49.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.22
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: Riverside University Health MISP |
$56.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC WORK HARDENING INITIAL 2HR OT
|
Facility
IP
|
$142.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
903207545
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
|
|
HC WORK HARDENING INITIAL 2HR PT
|
Facility
OP
|
$142.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
903200154
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$519.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$519.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$78.10
|
| 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: BCBS Transplant Transplant |
$85.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$106.50
|
| Rate for Payer: IEHP medi-cal |
$49.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.22
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: Riverside University Health MISP |
$56.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC WORK HARDENING INITIAL 2HR PT
|
Facility
IP
|
$142.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
903200154
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
|
|
HC WORK TOLERANCE TESTING OT
|
Facility
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 97660
|
| Hospital Charge Code |
903207660
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$238.20 |
| Max. Negotiated Rate |
$1,071.90 |
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Central Health Plan Commercial |
$952.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.40
|
| Rate for Payer: Galaxy Health WC |
$1,012.35
|
| Rate for Payer: Global Benefits Group Commercial |
$714.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,071.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$794.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.20
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| Rate for Payer: Networks By Design Commercial |
$774.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,012.35
|
|
|
HC WORK TOLERANCE TESTING OT
|
Facility
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 97660
|
| Hospital Charge Code |
903207660
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,071.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$723.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,012.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$655.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$655.05
|
| 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: BCBS Transplant Transplant |
$714.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Central Health Plan Commercial |
$952.80
|
| Rate for Payer: Cigna of CA HMO |
$762.24
|
| Rate for Payer: Cigna of CA PPO |
$881.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,012.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$476.40
|
| Rate for Payer: Galaxy Health WC |
$1,012.35
|
| Rate for Payer: Global Benefits Group Commercial |
$714.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,071.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$893.25
|
| Rate for Payer: IEHP medi-cal |
$416.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$794.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.31
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| Rate for Payer: Networks By Design Commercial |
$774.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,012.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$714.60
|
| Rate for Payer: Riverside University Health MISP |
$476.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$714.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$714.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,012.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,012.35
|
|
|
HC WORK TOLERANCE TESTING PT
|
Facility
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 97660
|
| Hospital Charge Code |
903200164
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$238.20 |
| Max. Negotiated Rate |
$1,071.90 |
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Central Health Plan Commercial |
$952.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.40
|
| Rate for Payer: Galaxy Health WC |
$1,012.35
|
| Rate for Payer: Global Benefits Group Commercial |
$714.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,071.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$794.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.20
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| Rate for Payer: Networks By Design Commercial |
$774.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,012.35
|
|
|
HC WORK TOLERANCE TESTING PT
|
Facility
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 97660
|
| Hospital Charge Code |
903200164
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,071.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$723.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,012.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$655.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$655.05
|
| 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: BCBS Transplant Transplant |
$714.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Cash Price |
$535.95
|
| Rate for Payer: Central Health Plan Commercial |
$952.80
|
| Rate for Payer: Cigna of CA HMO |
$762.24
|
| Rate for Payer: Cigna of CA PPO |
$881.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,012.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$476.40
|
| Rate for Payer: Galaxy Health WC |
$1,012.35
|
| Rate for Payer: Global Benefits Group Commercial |
$714.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,071.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$893.25
|
| Rate for Payer: IEHP medi-cal |
$416.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$794.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.31
|
| Rate for Payer: Multiplan Commercial |
$893.25
|
| Rate for Payer: Networks By Design Commercial |
$774.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,012.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$714.60
|
| Rate for Payer: Riverside University Health MISP |
$476.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$714.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$714.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,012.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,012.35
|
|
|
HC WOUND CLOSURE BY ADHESIVE
|
Facility
OP
|
$285.00
|
|
| Hospital Charge Code |
902890217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$173.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$156.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$156.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.38
|
| Rate for Payer: BCBS Transplant Transplant |
$171.00
|
| Rate for Payer: Blue Shield of California Commercial |
$179.26
|
| Rate for Payer: Blue Shield of California EPN |
$139.36
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Central Health Plan Commercial |
$228.00
|
| Rate for Payer: Cigna of CA HMO |
$182.40
|
| Rate for Payer: Cigna of CA PPO |
$210.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$242.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$213.75
|
| Rate for Payer: IEHP medi-cal |
$99.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$171.00
|
| Rate for Payer: Riverside University Health MISP |
$114.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.50
|
| Rate for Payer: United Healthcare All Other HMO |
$142.50
|
| Rate for Payer: United Healthcare HMO Rider |
$142.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.25
|
| Rate for Payer: Vantage Medical Group Senior |
$242.25
|
|
|
HC WOUND CLOSURE BY ADHESIVE
|
Facility
IP
|
$285.00
|
|
| Hospital Charge Code |
902890217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Central Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
|
|
HC WOUND CLOSURE STRIP .5X4IN
|
Facility
OP
|
$6.15
|
|
| Hospital Charge Code |
901698703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.63
|
| Rate for Payer: BCBS Transplant Transplant |
$3.69
|
| Rate for Payer: Blue Shield of California Commercial |
$3.87
|
| Rate for Payer: Blue Shield of California EPN |
$3.01
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Central Health Plan Commercial |
$4.92
|
| Rate for Payer: Cigna of CA HMO |
$3.94
|
| Rate for Payer: Cigna of CA PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.61
|
| Rate for Payer: IEHP medi-cal |
$2.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.61
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.69
|
| Rate for Payer: Riverside University Health MISP |
$2.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Vantage Medical Group Senior |
$5.23
|
|
|
HC WOUND CLOSURE STRIP .5X4IN
|
Facility
IP
|
$6.15
|
|
| Hospital Charge Code |
901698703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Central Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.61
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
|
|
HC WOUND CROWN- FISTULA MGMT
|
Facility
IP
|
$382.80
|
|
| Hospital Charge Code |
901608082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.52 |
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.38
|
| Rate for Payer: Global Benefits Group Commercial |
$229.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.10
|
| Rate for Payer: Networks By Design Commercial |
$248.82
|
| Rate for Payer: Prime Health Services Commercial |
$325.38
|
|
|
HC WOUND CROWN- FISTULA MGMT
|
Facility
OP
|
$382.80
|
|
| Hospital Charge Code |
901608082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$344.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$232.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$325.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$210.54
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$210.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.16
|
| Rate for Payer: BCBS Transplant Transplant |
$229.68
|
| Rate for Payer: Blue Shield of California Commercial |
$240.78
|
| Rate for Payer: Blue Shield of California EPN |
$187.19
|
| Rate for Payer: Cash Price |
$172.26
|
| Rate for Payer: Central Health Plan Commercial |
$306.24
|
| Rate for Payer: Cigna of CA HMO |
$244.99
|
| Rate for Payer: Cigna of CA PPO |
$283.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$325.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$153.12
|
| Rate for Payer: Galaxy Health WC |
$325.38
|
| Rate for Payer: Global Benefits Group Commercial |
$229.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$344.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$287.10
|
| Rate for Payer: IEHP medi-cal |
$133.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.56
|
| Rate for Payer: Multiplan Commercial |
$287.10
|
| Rate for Payer: Networks By Design Commercial |
$248.82
|
| Rate for Payer: Prime Health Services Commercial |
$325.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$229.68
|
| Rate for Payer: Riverside University Health MISP |
$153.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$191.40
|
| Rate for Payer: United Healthcare All Other HMO |
$191.40
|
| Rate for Payer: United Healthcare HMO Rider |
$191.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$191.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$325.38
|
| Rate for Payer: Vantage Medical Group Senior |
$325.38
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
IP
|
$9,552.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,910.40 |
| Max. Negotiated Rate |
$8,596.80 |
| Rate for Payer: Cash Price |
$4,298.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,641.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,820.80
|
| Rate for Payer: Galaxy Health WC |
$8,119.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,731.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,596.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,371.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,910.40
|
| Rate for Payer: Multiplan Commercial |
$7,164.00
|
| Rate for Payer: Networks By Design Commercial |
$6,208.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,119.20
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
OP
|
$9,552.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,596.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,731.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$4,298.40
|
| Rate for Payer: Cash Price |
$4,298.40
|
| Rate for Payer: Cash Price |
$4,298.40
|
| Rate for Payer: Cash Price |
$4,298.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,641.60
|
| Rate for Payer: Cigna of CA PPO |
$7,068.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$8,119.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,731.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,596.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,164.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,371.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,910.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$7,164.00
|
| Rate for Payer: Networks By Design Commercial |
$6,208.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,119.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,731.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,731.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,776.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,776.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,776.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
IP
|
$9,552.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,910.40 |
| Max. Negotiated Rate |
$8,596.80 |
| Rate for Payer: Cash Price |
$4,298.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,641.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,820.80
|
| Rate for Payer: Galaxy Health WC |
$8,119.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,731.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,596.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,371.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,910.40
|
| Rate for Payer: Multiplan Commercial |
$7,164.00
|
| Rate for Payer: Networks By Design Commercial |
$6,208.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,119.20
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
OP
|
$9,552.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,284.88 |
| Max. Negotiated Rate |
$8,596.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,284.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,731.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,008.21
|
| Rate for Payer: Blue Shield of California EPN |
$4,670.93
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$4,298.40
|
| Rate for Payer: Cash Price |
$4,298.40
|
| Rate for Payer: Central Health Plan Commercial |
$7,641.60
|
| Rate for Payer: Cigna of CA HMO |
$6,113.28
|
| Rate for Payer: Cigna of CA PPO |
$7,068.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$8,119.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,731.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,596.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,164.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,371.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,910.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$7,164.00
|
| Rate for Payer: Networks By Design Commercial |
$6,208.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,119.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,731.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,731.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,731.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,776.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,776.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,776.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC WOUND EXPLORATION TRAUMA EXTRE
|
Facility
OP
|
$8,172.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
900501282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,354.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,903.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,537.60
|
| Rate for Payer: Cigna of CA PPO |
$6,047.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$6,946.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,903.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,354.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,129.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Innovage PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,450.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,634.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$6,129.00
|
| Rate for Payer: Networks By Design Commercial |
$5,311.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,946.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,903.20
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,903.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,086.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,086.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,086.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,086.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC WOUND EXPLORATION TRAUMA EXTRE
|
Facility
IP
|
$8,172.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
900501282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,634.40 |
| Max. Negotiated Rate |
$7,354.80 |
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,537.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,268.80
|
| Rate for Payer: Galaxy Health WC |
$6,946.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,903.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,354.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,634.40
|
| Rate for Payer: Multiplan Commercial |
$6,129.00
|
| Rate for Payer: Networks By Design Commercial |
$5,311.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,946.20
|
|
|
HC WOUND MATRIX NEOX 100 2.0X2.0
|
Facility
OP
|
$678.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.43 |
| Max. Negotiated Rate |
$916.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$916.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$576.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$372.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$372.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$294.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.33
|
| Rate for Payer: BCBS Transplant Transplant |
$406.80
|
| Rate for Payer: Blue Shield of California Commercial |
$426.46
|
| Rate for Payer: Blue Shield of California EPN |
$331.54
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Central Health Plan Commercial |
$542.40
|
| Rate for Payer: Cigna of CA HMO |
$474.60
|
| Rate for Payer: Cigna of CA PPO |
$474.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$576.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$271.20
|
| Rate for Payer: Galaxy Health WC |
$576.30
|
| Rate for Payer: Global Benefits Group Commercial |
$406.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$610.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$508.50
|
| Rate for Payer: IEHP medi-cal |
$68.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$452.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$508.50
|
| Rate for Payer: Networks By Design Commercial |
$339.00
|
| Rate for Payer: Prime Health Services Commercial |
$576.30
|
| Rate for Payer: Riverside University Health MISP |
$271.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$406.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$406.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.00
|
| Rate for Payer: United Healthcare All Other HMO |
$339.00
|
| Rate for Payer: United Healthcare HMO Rider |
$339.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$339.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$576.30
|
| Rate for Payer: Vantage Medical Group Senior |
$576.30
|
|
|
HC WOUND MATRIX NEOX 100 2.0X2.0
|
Facility
IP
|
$678.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$610.20 |
| Rate for Payer: Blue Shield of California Commercial |
$508.50
|
| Rate for Payer: Blue Shield of California EPN |
$362.05
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Central Health Plan Commercial |
$542.40
|
| Rate for Payer: Cigna of CA HMO |
$474.60
|
| Rate for Payer: Cigna of CA PPO |
$474.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$271.20
|
| Rate for Payer: Galaxy Health WC |
$576.30
|
| Rate for Payer: Global Benefits Group Commercial |
$406.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$610.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$452.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$508.50
|
| Rate for Payer: Networks By Design Commercial |
$339.00
|
| Rate for Payer: Prime Health Services Commercial |
$576.30
|
|
|
HC WOUND MATRIX NEOX 100 3.0X3.0
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$387.90 |
| Rate for Payer: Blue Shield of California Commercial |
$323.25
|
| Rate for Payer: Blue Shield of California EPN |
$230.15
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: Cigna of CA HMO |
$301.70
|
| Rate for Payer: Cigna of CA PPO |
$301.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$215.50
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
|
|
HC WOUND MATRIX NEOX 100 3.0X3.0
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.43 |
| Max. Negotiated Rate |
$916.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$916.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$366.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$237.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$237.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$294.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.33
|
| Rate for Payer: BCBS Transplant Transplant |
$258.60
|
| Rate for Payer: Blue Shield of California Commercial |
$271.10
|
| Rate for Payer: Blue Shield of California EPN |
$210.76
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Cash Price |
$193.95
|
| Rate for Payer: Central Health Plan Commercial |
$344.80
|
| Rate for Payer: Cigna of CA HMO |
$301.70
|
| Rate for Payer: Cigna of CA PPO |
$301.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$366.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$172.40
|
| Rate for Payer: Galaxy Health WC |
$366.35
|
| Rate for Payer: Global Benefits Group Commercial |
$258.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$323.25
|
| Rate for Payer: IEHP medi-cal |
$68.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$287.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.20
|
| Rate for Payer: Multiplan Commercial |
$323.25
|
| Rate for Payer: Networks By Design Commercial |
$215.50
|
| Rate for Payer: Prime Health Services Commercial |
$366.35
|
| Rate for Payer: Riverside University Health MISP |
$172.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.50
|
| Rate for Payer: United Healthcare All Other HMO |
$215.50
|
| Rate for Payer: United Healthcare HMO Rider |
$215.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$366.35
|
| Rate for Payer: Vantage Medical Group Senior |
$366.35
|
|
|
HC WOUND MATRIX NEOX 100 4.0X4.0
|
Facility
OP
|
$244.00
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$916.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$916.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$134.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$294.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.33
|
| Rate for Payer: BCBS Transplant Transplant |
$146.40
|
| Rate for Payer: Blue Shield of California Commercial |
$153.48
|
| Rate for Payer: Blue Shield of California EPN |
$119.32
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$183.00
|
| Rate for Payer: IEHP medi-cal |
$68.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$122.00
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Riverside University Health MISP |
$97.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.00
|
| Rate for Payer: United Healthcare All Other HMO |
$122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
