|
HC WOUND MATRIX NEOX 100 4.0X4.0
|
Facility
|
OP
|
$322.59
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$360.59 |
| Rate for Payer: Adventist Health Commercial |
$64.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$199.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.59
|
| Rate for Payer: Blue Shield of California Commercial |
$196.78
|
| Rate for Payer: Blue Shield of California EPN |
$157.42
|
| Rate for Payer: Cash Price |
$145.17
|
| Rate for Payer: Cash Price |
$145.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.46
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.36
|
| Rate for Payer: Heritage Provider Network Senior |
$149.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$153.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$241.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$129.04
|
| Rate for Payer: TriValley Medical Group Senior |
$129.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC WOUND MATRIX NEOX 100 4.0X4.0
|
Facility
|
IP
|
$322.59
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$241.94 |
| Rate for Payer: Adventist Health Commercial |
$64.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$207.75
|
| Rate for Payer: Cash Price |
$145.17
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.36
|
| Rate for Payer: Heritage Provider Network Senior |
$149.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.65
|
| Rate for Payer: Multiplan Commercial |
$241.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.81
|
|
|
HC WOUND MATRIX NEOX 100 7.0X7.0
|
Facility
|
IP
|
$218.60
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.57 |
| Max. Negotiated Rate |
$163.95 |
| Rate for Payer: Adventist Health Commercial |
$43.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$140.78
|
| Rate for Payer: Cash Price |
$98.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.21
|
| Rate for Payer: Heritage Provider Network Senior |
$101.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.65
|
| Rate for Payer: Multiplan Commercial |
$163.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$78.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$72.38
|
|
|
HC WOUND MATRIX NEOX 100 7.0X7.0
|
Facility
|
OP
|
$218.60
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.57 |
| Max. Negotiated Rate |
$360.59 |
| Rate for Payer: Adventist Health Commercial |
$43.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$135.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.59
|
| Rate for Payer: Blue Shield of California Commercial |
$133.35
|
| Rate for Payer: Blue Shield of California EPN |
$106.68
|
| Rate for Payer: Cash Price |
$98.37
|
| Rate for Payer: Cash Price |
$98.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.21
|
| Rate for Payer: Heritage Provider Network Senior |
$101.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$104.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$163.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$87.44
|
| Rate for Payer: TriValley Medical Group Senior |
$87.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$78.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$72.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC WOUND MATRIX NEOX FLO 100MG PARTICULATE
|
Facility
|
OP
|
$42.55
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$36.17 |
| Rate for Payer: Adventist Health Commercial |
$8.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.28
|
| Rate for Payer: Blue Shield of California Commercial |
$25.96
|
| Rate for Payer: Blue Shield of California EPN |
$20.76
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.70
|
| Rate for Payer: Heritage Provider Network Senior |
$19.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$31.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.02
|
| Rate for Payer: TriValley Medical Group Senior |
$17.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.17
|
| Rate for Payer: Vantage Medical Group Senior |
$36.17
|
|
|
HC WOUND MATRIX NEOX FLO 100MG PARTICULATE
|
Facility
|
IP
|
$42.55
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$31.91 |
| Rate for Payer: Adventist Health Commercial |
$8.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$27.40
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.70
|
| Rate for Payer: Heritage Provider Network Senior |
$19.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.64
|
| Rate for Payer: Multiplan Commercial |
$31.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.09
|
|
|
HC WOUND MATRIX NEOX FLO 150MG PARTICULATE
|
Facility
|
OP
|
$41.81
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$35.54 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.91
|
| Rate for Payer: Blue Shield of California Commercial |
$25.50
|
| Rate for Payer: Blue Shield of California EPN |
$20.40
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.36
|
| Rate for Payer: Heritage Provider Network Senior |
$19.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$19.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.27
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.72
|
| Rate for Payer: TriValley Medical Group Senior |
$16.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.54
|
| Rate for Payer: Vantage Medical Group Senior |
$35.54
|
|
|
HC WOUND MATRIX NEOX FLO 150MG PARTICULATE
|
Facility
|
IP
|
$41.81
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26.93
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.36
|
| Rate for Payer: Heritage Provider Network Senior |
$19.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.84
|
|
|
HC WOUND MATRIX NEOX FLO 25MG PARTICULATE
|
Facility
|
IP
|
$84.80
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Adventist Health Commercial |
$16.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.61
|
| Rate for Payer: Cash Price |
$38.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.26
|
| Rate for Payer: Heritage Provider Network Senior |
$39.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$63.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.08
|
|
|
HC WOUND MATRIX NEOX FLO 25MG PARTICULATE
|
Facility
|
OP
|
$84.80
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$72.08 |
| Rate for Payer: Adventist Health Commercial |
$16.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.42
|
| Rate for Payer: Blue Shield of California Commercial |
$51.73
|
| Rate for Payer: Blue Shield of California EPN |
$41.38
|
| Rate for Payer: Cash Price |
$38.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.26
|
| Rate for Payer: Heritage Provider Network Senior |
$39.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$59.36
|
| Rate for Payer: Multiplan Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.92
|
| Rate for Payer: TriValley Medical Group Senior |
$33.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.08
|
| Rate for Payer: Vantage Medical Group Senior |
$72.08
|
|
|
HC WOUND MATRIX NEOX FLO 50MG PARTICULATE
|
Facility
|
IP
|
$55.20
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$11.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35.55
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.56
|
| Rate for Payer: Heritage Provider Network Senior |
$25.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.80
|
| Rate for Payer: Multiplan Commercial |
$41.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.28
|
|
|
HC WOUND MATRIX NEOX FLO 50MG PARTICULATE
|
Facility
|
OP
|
$55.20
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Adventist Health Commercial |
$11.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.61
|
| Rate for Payer: Blue Shield of California Commercial |
$33.67
|
| Rate for Payer: Blue Shield of California EPN |
$26.94
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.56
|
| Rate for Payer: Heritage Provider Network Senior |
$25.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$26.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$41.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.08
|
| Rate for Payer: TriValley Medical Group Senior |
$22.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.92
|
| Rate for Payer: Vantage Medical Group Senior |
$46.92
|
|
|
HC WRIST ARTHROGRAPHY INJECT
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
909000115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$320.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$285.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$389.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$337.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$441.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$441.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$321.26
|
| Rate for Payer: Heritage Provider Network Senior |
$321.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$247.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$363.30
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$441.15
|
| Rate for Payer: Vantage Medical Group Senior |
$441.15
|
|
|
HC WRIST ARTHROGRAPHY INJECT
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
909000115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.94 |
| Max. Negotiated Rate |
$389.25 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$334.24
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.36
|
| Rate for Payer: Heritage Provider Network Senior |
$351.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
|
|
HC WRIST COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
909001210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$512.25 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$422.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.08
|
| Rate for Payer: Blue Shield of California Commercial |
$109.97
|
| Rate for Payer: Blue Shield of California EPN |
$88.43
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$443.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$422.78
|
| Rate for Payer: Heritage Provider Network Senior |
$422.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$325.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC WRIST COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
909001210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.62 |
| Max. Negotiated Rate |
$512.25 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$439.85
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$462.39
|
| Rate for Payer: Heritage Provider Network Senior |
$462.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.75
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
|
|
HC WRIST LIMITED
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
909001514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$358.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.98
|
| Rate for Payer: Blue Shield of California Commercial |
$101.86
|
| Rate for Payer: Blue Shield of California EPN |
$81.91
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$377.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$359.02
|
| Rate for Payer: Heritage Provider Network Senior |
$359.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$276.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC WRIST LIMITED
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
909001514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.52
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
|
|
HC XA INHIBITION LMW HEPARIN
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900910107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$105.60 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Adventist Health Commercial |
$23.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$73.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$76.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.60
|
| Rate for Payer: Blue Shield of California Commercial |
$105.35
|
| Rate for Payer: Blue Shield of California Commercial |
$105.35
|
| Rate for Payer: Blue Shield of California EPN |
$84.50
|
| Rate for Payer: Blue Shield of California EPN |
$84.50
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$77.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$79.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.21
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$76.14
|
| Rate for Payer: Heritage Provider Network Senior |
$73.66
|
| Rate for Payer: Heritage Provider Network Senior |
$76.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$56.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$58.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$89.25
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.09
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.09
|
| Rate for Payer: TriValley Medical Group Senior |
$13.09
|
| Rate for Payer: TriValley Medical Group Senior |
$13.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC XA INHIBITION LMW HEPARIN
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900910107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.26 |
| Max. Negotiated Rate |
$92.25 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$79.21
|
| Rate for Payer: Cash Price |
$55.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.27
|
| Rate for Payer: Heritage Provider Network Senior |
$83.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.75
|
| Rate for Payer: Multiplan Commercial |
$92.25
|
|
|
HC XE 133, PER 10 MCI
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT A9558
|
| Hospital Charge Code |
909301526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$304.61
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.00
|
| Rate for Payer: Heritage Provider Network Senior |
$219.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$170.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.61
|
|
|
HC XE 133, PER 10 MCI
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT A9558
|
| Hospital Charge Code |
909301526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.15 |
| Max. Negotiated Rate |
$402.05 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.15
|
| Rate for Payer: Blue Shield of California Commercial |
$288.53
|
| Rate for Payer: Blue Shield of California EPN |
$230.82
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.00
|
| Rate for Payer: Heritage Provider Network Senior |
$219.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$225.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$331.10
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$189.20
|
| Rate for Payer: TriValley Medical Group Senior |
$189.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$170.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$402.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.05
|
| Rate for Payer: Vantage Medical Group Senior |
$402.05
|
|
|
HC XENON PERFUSION SCAN
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$264.62 |
| Max. Negotiated Rate |
$1,096.50 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$941.53
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$989.77
|
| Rate for Payer: Heritage Provider Network Senior |
$989.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$264.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.50
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
|
|
HC XENON PERFUSION SCAN
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$264.62 |
| Max. Negotiated Rate |
$1,189.08 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$903.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,189.08
|
| Rate for Payer: Blue Shield of California Commercial |
$897.70
|
| Rate for Payer: Blue Shield of California EPN |
$721.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$950.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$904.98
|
| Rate for Payer: Heritage Provider Network Senior |
$904.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$697.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$264.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$731.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC XPEEDIOR ANGIOJET, CATH
|
Facility
|
OP
|
$2,556.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,579.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,405.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,917.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,027.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,027.51
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,175.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,172.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,172.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,635.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,183.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,183.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,278.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,278.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,278.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,789.20
|
| Rate for Payer: Multiplan Commercial |
$1,917.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$923.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$846.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,172.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,172.60
|
|
