|
HC CORD HC WOUND MATRIX NEOX 1K 2.0X1.0
|
Facility
IP
|
$1,046.75
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.46 |
| Max. Negotiated Rate |
$785.06 |
| Rate for Payer: Adventist Health Commercial |
$209.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.12
|
| Rate for Payer: Cash Price |
$471.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.65
|
| Rate for Payer: Heritage Provider Network Senior |
$708.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.69
|
| Rate for Payer: Multiplan Commercial |
$785.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$381.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$349.72
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 2.0X1.0
|
Facility
OP
|
$1,046.75
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102195
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.46 |
| Max. Negotiated Rate |
$889.74 |
| Rate for Payer: Adventist Health Commercial |
$209.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$545.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$889.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$575.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$785.06
|
| Rate for Payer: Blue Shield of California Commercial |
$650.03
|
| Rate for Payer: Blue Shield of California EPN |
$614.44
|
| Rate for Payer: Cash Price |
$471.04
|
| Rate for Payer: Cash Price |
$471.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$889.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$889.74
|
| Rate for Payer: Dignity Health Senior |
$889.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.65
|
| Rate for Payer: Heritage Provider Network Senior |
$484.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$504.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.69
|
| Rate for Payer: Multiplan Commercial |
$785.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$381.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$349.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$889.74
|
| Rate for Payer: Vantage Medical Group Senior |
$889.74
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 2.0X2.0
|
Facility
OP
|
$914.25
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$777.11 |
| Rate for Payer: Adventist Health Commercial |
$182.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$545.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$628.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$777.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$502.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$685.69
|
| Rate for Payer: Blue Shield of California Commercial |
$567.75
|
| Rate for Payer: Blue Shield of California EPN |
$536.66
|
| Rate for Payer: Cash Price |
$411.41
|
| Rate for Payer: Cash Price |
$411.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$420.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$777.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$777.11
|
| Rate for Payer: Dignity Health Senior |
$777.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$585.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.30
|
| Rate for Payer: Heritage Provider Network Senior |
$423.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$440.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.56
|
| Rate for Payer: Multiplan Commercial |
$685.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$333.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$777.11
|
| Rate for Payer: Vantage Medical Group Senior |
$777.11
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 2.0X2.0
|
Facility
IP
|
$914.25
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102196
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$685.69 |
| Rate for Payer: Adventist Health Commercial |
$182.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$628.09
|
| Rate for Payer: Cash Price |
$411.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$420.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$618.95
|
| Rate for Payer: Heritage Provider Network Senior |
$618.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.56
|
| Rate for Payer: Multiplan Commercial |
$685.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$333.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.45
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 3.0X2.0
|
Facility
OP
|
$736.92
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$626.38 |
| Rate for Payer: Adventist Health Commercial |
$147.38
|
| Rate for Payer: Aetna of CA Gatekeeper |
$545.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$626.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$405.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$552.69
|
| Rate for Payer: Blue Shield of California Commercial |
$457.63
|
| Rate for Payer: Blue Shield of California EPN |
$432.57
|
| Rate for Payer: Cash Price |
$331.61
|
| Rate for Payer: Cash Price |
$331.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$338.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.38
|
| Rate for Payer: Dignity Health Senior |
$626.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$341.19
|
| Rate for Payer: Heritage Provider Network Senior |
$341.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$355.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.23
|
| Rate for Payer: Multiplan Commercial |
$552.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$268.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$246.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.38
|
| Rate for Payer: Vantage Medical Group Senior |
$626.38
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 3.0X2.0
|
Facility
IP
|
$736.92
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.38 |
| Max. Negotiated Rate |
$552.69 |
| Rate for Payer: Adventist Health Commercial |
$147.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.26
|
| Rate for Payer: Cash Price |
$331.61
|
| Rate for Payer: Cigna of CA HMO/PPO |
$338.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.89
|
| Rate for Payer: Heritage Provider Network Senior |
$498.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.23
|
| Rate for Payer: Multiplan Commercial |
$552.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$268.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$246.20
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 3.0X3.0
|
Facility
OP
|
$573.50
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$545.08 |
| Rate for Payer: Adventist Health Commercial |
$114.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$545.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$393.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$487.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$315.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$430.12
|
| Rate for Payer: Blue Shield of California Commercial |
$356.14
|
| Rate for Payer: Blue Shield of California EPN |
$336.64
|
| Rate for Payer: Cash Price |
$258.08
|
| Rate for Payer: Cash Price |
$258.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$263.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$487.48
|
| Rate for Payer: Dignity Health Senior |
$487.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.53
|
| Rate for Payer: Heritage Provider Network Senior |
$265.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$276.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.38
|
| Rate for Payer: Multiplan Commercial |
$430.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$209.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$191.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$487.48
|
| Rate for Payer: Vantage Medical Group Senior |
$487.48
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 3.0X3.0
|
Facility
IP
|
$573.50
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$430.12 |
| Rate for Payer: Adventist Health Commercial |
$114.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$393.99
|
| Rate for Payer: Cash Price |
$258.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$263.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$388.26
|
| Rate for Payer: Heritage Provider Network Senior |
$388.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.38
|
| Rate for Payer: Multiplan Commercial |
$430.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$209.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$191.61
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 4.0X3.0
|
Facility
IP
|
$460.96
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$345.72 |
| Rate for Payer: Adventist Health Commercial |
$92.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.68
|
| Rate for Payer: Cash Price |
$207.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$212.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.07
|
| Rate for Payer: Heritage Provider Network Senior |
$312.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.24
|
| Rate for Payer: Multiplan Commercial |
$345.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$168.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.01
|
|
|
HC CORD HC WOUND MATRIX NEOX 1K 4.0X3.0
|
Facility
OP
|
$460.96
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$545.08 |
| Rate for Payer: Adventist Health Commercial |
$92.19
|
| Rate for Payer: Aetna of CA Gatekeeper |
$545.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$391.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$253.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$345.72
|
| Rate for Payer: Blue Shield of California Commercial |
$286.26
|
| Rate for Payer: Blue Shield of California EPN |
$270.58
|
| Rate for Payer: Cash Price |
$207.43
|
| Rate for Payer: Cash Price |
$207.43
|
| Rate for Payer: Cigna of CA HMO/PPO |
$212.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$391.82
|
| Rate for Payer: Dignity Health Senior |
$391.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.42
|
| Rate for Payer: Heritage Provider Network Senior |
$213.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$222.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.24
|
| Rate for Payer: Multiplan Commercial |
$345.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$168.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$391.82
|
| Rate for Payer: Vantage Medical Group Senior |
$391.82
|
|
|
HC CORD NEOX RT 2.0X1.0CM
|
Facility
OP
|
$1,046.75
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.46 |
| Max. Negotiated Rate |
$889.74 |
| Rate for Payer: Adventist Health Commercial |
$209.35
|
| Rate for Payer: Aetna of CA Gatekeeper |
$545.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$889.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$575.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$785.06
|
| Rate for Payer: Blue Shield of California Commercial |
$650.03
|
| Rate for Payer: Blue Shield of California EPN |
$614.44
|
| Rate for Payer: Cash Price |
$471.04
|
| Rate for Payer: Cash Price |
$471.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$889.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$889.74
|
| Rate for Payer: Dignity Health Senior |
$889.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.65
|
| Rate for Payer: Heritage Provider Network Senior |
$484.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$504.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.69
|
| Rate for Payer: Multiplan Commercial |
$785.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$381.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$349.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$889.74
|
| Rate for Payer: Vantage Medical Group Senior |
$889.74
|
|
|
HC CORD NEOX RT 2.0X1.0CM
|
Facility
IP
|
$1,046.75
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.46 |
| Max. Negotiated Rate |
$785.06 |
| Rate for Payer: Adventist Health Commercial |
$209.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.12
|
| Rate for Payer: Cash Price |
$471.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.65
|
| Rate for Payer: Heritage Provider Network Senior |
$708.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.69
|
| Rate for Payer: Multiplan Commercial |
$785.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$381.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$349.72
|
|
|
HC CORD NEOX RT 2.0X2.0CM
|
Facility
OP
|
$914.25
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$777.11 |
| Rate for Payer: Adventist Health Commercial |
$182.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$545.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$628.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$777.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$502.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$685.69
|
| Rate for Payer: Blue Shield of California Commercial |
$567.75
|
| Rate for Payer: Blue Shield of California EPN |
$536.66
|
| Rate for Payer: Cash Price |
$411.41
|
| Rate for Payer: Cash Price |
$411.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$420.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$777.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$777.11
|
| Rate for Payer: Dignity Health Senior |
$777.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$585.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.30
|
| Rate for Payer: Heritage Provider Network Senior |
$423.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$440.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.56
|
| Rate for Payer: Multiplan Commercial |
$685.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$333.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$777.11
|
| Rate for Payer: Vantage Medical Group Senior |
$777.11
|
|
|
HC CORD NEOX RT 2.0X2.0CM
|
Facility
IP
|
$914.25
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.48 |
| Max. Negotiated Rate |
$685.69 |
| Rate for Payer: Adventist Health Commercial |
$182.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$628.09
|
| Rate for Payer: Cash Price |
$411.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$420.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$618.95
|
| Rate for Payer: Heritage Provider Network Senior |
$618.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.56
|
| Rate for Payer: Multiplan Commercial |
$685.69
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$333.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.45
|
|
|
HC CORD NEOX RT 3.0X2.0CM
|
Facility
IP
|
$675.25
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.22 |
| Max. Negotiated Rate |
$506.44 |
| Rate for Payer: Adventist Health Commercial |
$135.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.90
|
| Rate for Payer: Cash Price |
$303.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$457.14
|
| Rate for Payer: Heritage Provider Network Senior |
$457.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.81
|
| Rate for Payer: Multiplan Commercial |
$506.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$225.60
|
|
|
HC CORD NEOX RT 3.0X2.0CM
|
Facility
OP
|
$675.25
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.22 |
| Max. Negotiated Rate |
$573.96 |
| Rate for Payer: Adventist Health Commercial |
$135.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$545.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$573.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$371.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$506.44
|
| Rate for Payer: Blue Shield of California Commercial |
$419.33
|
| Rate for Payer: Blue Shield of California EPN |
$396.37
|
| Rate for Payer: Cash Price |
$303.86
|
| Rate for Payer: Cash Price |
$303.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$573.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$573.96
|
| Rate for Payer: Dignity Health Senior |
$573.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.64
|
| Rate for Payer: Heritage Provider Network Senior |
$312.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$325.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.81
|
| Rate for Payer: Multiplan Commercial |
$506.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$246.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$225.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$573.96
|
| Rate for Payer: Vantage Medical Group Senior |
$573.96
|
|
|
HC CORD NEOX RT 3.0X3.0CM
|
Facility
OP
|
$491.28
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$545.08 |
| Rate for Payer: Adventist Health Commercial |
$98.26
|
| Rate for Payer: Aetna of CA Gatekeeper |
$545.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$337.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$417.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$270.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$368.46
|
| Rate for Payer: Blue Shield of California Commercial |
$305.08
|
| Rate for Payer: Blue Shield of California EPN |
$288.38
|
| Rate for Payer: Cash Price |
$221.08
|
| Rate for Payer: Cash Price |
$221.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$225.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$417.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.59
|
| Rate for Payer: Dignity Health Senior |
$417.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$227.46
|
| Rate for Payer: Heritage Provider Network Senior |
$227.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$236.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.82
|
| Rate for Payer: Multiplan Commercial |
$368.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$179.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.59
|
| Rate for Payer: Vantage Medical Group Senior |
$417.59
|
|
|
HC CORD NEOX RT 3.0X3.0CM
|
Facility
IP
|
$491.28
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$368.46 |
| Rate for Payer: Adventist Health Commercial |
$98.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$337.51
|
| Rate for Payer: Cash Price |
$221.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$225.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$332.60
|
| Rate for Payer: Heritage Provider Network Senior |
$332.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.82
|
| Rate for Payer: Multiplan Commercial |
$368.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$179.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.14
|
|
|
HC CORD NEOX RT 4.0X3.0CM
|
Facility
OP
|
$383.88
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.48 |
| Max. Negotiated Rate |
$545.08 |
| Rate for Payer: Adventist Health Commercial |
$76.78
|
| Rate for Payer: Aetna of CA Gatekeeper |
$545.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$263.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$326.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$211.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$287.91
|
| Rate for Payer: Blue Shield of California Commercial |
$238.39
|
| Rate for Payer: Blue Shield of California EPN |
$225.34
|
| Rate for Payer: Cash Price |
$172.75
|
| Rate for Payer: Cash Price |
$172.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$326.30
|
| Rate for Payer: Dignity Health Senior |
$326.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$245.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.74
|
| Rate for Payer: Heritage Provider Network Senior |
$177.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$185.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.97
|
| Rate for Payer: Multiplan Commercial |
$287.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$139.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$128.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$326.30
|
| Rate for Payer: Vantage Medical Group Senior |
$326.30
|
|
|
HC CORD NEOX RT 4.0X3.0CM
|
Facility
IP
|
$383.88
|
|
|
Service Code
|
CPT Q4148
|
| Hospital Charge Code |
900102204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.48 |
| Max. Negotiated Rate |
$287.91 |
| Rate for Payer: Adventist Health Commercial |
$76.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$263.73
|
| Rate for Payer: Cash Price |
$172.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$176.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$259.89
|
| Rate for Payer: Heritage Provider Network Senior |
$259.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.97
|
| Rate for Payer: Multiplan Commercial |
$287.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$139.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$128.25
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
IP
|
$685.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$513.75 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.60
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.74
|
| Rate for Payer: Heritage Provider Network Senior |
$463.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
|
|
HC CORDOCENTESIS INTRAUTERINE PUBS
|
Facility
OP
|
$685.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$445.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$425.38
|
| Rate for Payer: Blue Shield of California EPN |
$402.10
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.02
|
| Rate for Payer: Heritage Provider Network Senior |
$424.02
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: IEHP Medi-Cal |
$233.97
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$761.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$342.50
|
| Rate for Payer: TriValley Medical Group Senior |
$342.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CORDO INTRAUT PUBS ADDL FETUS
|
Facility
OP
|
$685.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$445.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$400.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$425.38
|
| Rate for Payer: Blue Shield of California EPN |
$402.10
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$601.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.90
|
| Rate for Payer: Dignity Health Senior |
$400.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$400.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$424.02
|
| Rate for Payer: Heritage Provider Network Senior |
$424.02
|
| Rate for Payer: Humana Medicare |
$400.82
|
| Rate for Payer: IEHP Medi-Cal |
$233.97
|
| Rate for Payer: IEHP Medicare Advantage |
$400.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$761.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$505.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$505.03
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$342.50
|
| Rate for Payer: TriValley Medical Group Senior |
$342.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$601.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.90
|
| Rate for Payer: Vantage Medical Group Senior |
$400.82
|
|
|
HC CORDO INTRAUT PUBS ADDL FETUS
|
Facility
IP
|
$685.00
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
910400085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$513.75 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.60
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.74
|
| Rate for Payer: Heritage Provider Network Senior |
$463.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
|
|
HC CORE NDL BX PERC INCL IMG GDNC
|
Facility
OP
|
$3,919.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
909000408
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$709.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$783.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,692.35
|
| 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 HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$1,763.55
|
| Rate for Payer: Cash Price |
$1,763.55
|
| Rate for Payer: Cash Price |
$1,763.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,547.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,425.86
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.60
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$1,370.66
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,848.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$979.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$2,939.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,228.26
|
| Rate for Payer: TriValley Medical Group Senior |
$2,228.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| 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
|
|
