|
HC COR A 1 (HAZELNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913735
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
HC COR A 1 (HAZELNUT), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913735
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC COR A 8 (HAZELNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
HC COR A 8 (HAZELNUT), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC COR A 9 (HAZELNUT), IGE
|
Facility
|
OP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$157.06 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Adventist Health Commercial |
$3.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.06
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California Commercial |
$127.53
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Blue Shield of California EPN |
$102.29
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cash Price |
$6.93
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.02
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.09
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Senior |
$9.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$11.56
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: TriValley Medical Group Senior |
$17.93
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$19.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC COR A 9 (HAZELNUT), IGE
|
Facility
|
IP
|
$18.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$13.87 |
| Rate for Payer: Adventist Health Commercial |
$3.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.91
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.52
|
| Rate for Payer: Heritage Provider Network Senior |
$12.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$13.87
|
|
|
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 |
$160.06 |
| Max. Negotiated Rate |
$785.06 |
| Rate for Payer: Adventist Health Commercial |
$209.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$646.89
|
| 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 |
$523.58
|
| Rate for Payer: Blue Shield of California Commercial |
$638.52
|
| Rate for Payer: Blue Shield of California EPN |
$510.81
|
| 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 |
$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 |
$669.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.65
|
| Rate for Payer: Heritage Provider Network Senior |
$484.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$499.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$785.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$418.70
|
| Rate for Payer: TriValley Medical Group Senior |
$418.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$346.58
|
| 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 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 |
$674.11
|
| Rate for Payer: Cash Price |
$471.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.65
|
| Rate for Payer: Heritage Provider Network Senior |
$484.65
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$378.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$346.58
|
|
|
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 |
$160.06 |
| Max. Negotiated Rate |
$685.69 |
| Rate for Payer: Adventist Health Commercial |
$182.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$565.01
|
| 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 |
$457.31
|
| Rate for Payer: Blue Shield of California Commercial |
$557.69
|
| Rate for Payer: Blue Shield of California EPN |
$446.15
|
| 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 |
$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 |
$585.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.30
|
| Rate for Payer: Heritage Provider Network Senior |
$423.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$436.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$685.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$365.70
|
| Rate for Payer: TriValley Medical Group Senior |
$365.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$330.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.71
|
| 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 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 |
$588.78
|
| Rate for Payer: Cash Price |
$411.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$420.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.30
|
| Rate for Payer: Heritage Provider Network Senior |
$423.30
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$330.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.71
|
|
|
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 |
$552.69 |
| Rate for Payer: Adventist Health Commercial |
$147.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$455.42
|
| 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 |
$368.61
|
| Rate for Payer: Blue Shield of California Commercial |
$449.52
|
| Rate for Payer: Blue Shield of California EPN |
$359.62
|
| 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 |
$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 |
$471.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$341.19
|
| Rate for Payer: Heritage Provider Network Senior |
$341.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$351.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$552.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$294.77
|
| Rate for Payer: TriValley Medical Group Senior |
$294.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.99
|
| 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 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 |
$474.58
|
| 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 |
$341.19
|
| Rate for Payer: Heritage Provider Network Senior |
$341.19
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$266.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.99
|
|
|
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 |
$369.33
|
| 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 |
$265.53
|
| Rate for Payer: Heritage Provider Network Senior |
$265.53
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$207.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.89
|
|
|
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 |
$430.12 |
| Rate for Payer: Adventist Health Commercial |
$114.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$354.42
|
| 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 |
$286.86
|
| Rate for Payer: Blue Shield of California Commercial |
$349.83
|
| Rate for Payer: Blue Shield of California EPN |
$279.87
|
| 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 |
$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 |
$367.04
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.53
|
| Rate for Payer: Heritage Provider Network Senior |
$265.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$273.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$430.12
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.40
|
| Rate for Payer: TriValley Medical Group Senior |
$229.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$207.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$189.89
|
| 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 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 |
$296.86
|
| 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 |
$213.42
|
| Rate for Payer: Heritage Provider Network Senior |
$213.42
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$166.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$152.62
|
|
|
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 |
$345.72 |
| Rate for Payer: Adventist Health Commercial |
$92.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.87
|
| 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 |
$230.57
|
| Rate for Payer: Blue Shield of California Commercial |
$281.19
|
| Rate for Payer: Blue Shield of California EPN |
$224.95
|
| 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 |
$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 |
$295.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.42
|
| Rate for Payer: Heritage Provider Network Senior |
$213.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$219.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$345.72
|
| Rate for Payer: TriValley Medical Group Commercial |
$184.38
|
| Rate for Payer: TriValley Medical Group Senior |
$184.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$166.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$152.62
|
| 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 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 |
$674.11
|
| Rate for Payer: Cash Price |
$471.04
|
| Rate for Payer: Cigna of CA HMO/PPO |
$481.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.65
|
| Rate for Payer: Heritage Provider Network Senior |
$484.65
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$378.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$346.58
|
|
|
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 |
$160.06 |
| Max. Negotiated Rate |
$785.06 |
| Rate for Payer: Adventist Health Commercial |
$209.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$646.89
|
| 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 |
$523.58
|
| Rate for Payer: Blue Shield of California Commercial |
$638.52
|
| Rate for Payer: Blue Shield of California EPN |
$510.81
|
| 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 |
$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 |
$669.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$484.65
|
| Rate for Payer: Heritage Provider Network Senior |
$484.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$499.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$785.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$418.70
|
| Rate for Payer: TriValley Medical Group Senior |
$418.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$378.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$346.58
|
| 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 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 |
$160.06 |
| Max. Negotiated Rate |
$685.69 |
| Rate for Payer: Adventist Health Commercial |
$182.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$565.01
|
| 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 |
$457.31
|
| Rate for Payer: Blue Shield of California Commercial |
$557.69
|
| Rate for Payer: Blue Shield of California EPN |
$446.15
|
| 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 |
$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 |
$585.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.30
|
| Rate for Payer: Heritage Provider Network Senior |
$423.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$436.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$685.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$365.70
|
| Rate for Payer: TriValley Medical Group Senior |
$365.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$330.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.71
|
| 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 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 |
$588.78
|
| Rate for Payer: Cash Price |
$411.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$420.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$423.30
|
| Rate for Payer: Heritage Provider Network Senior |
$423.30
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$330.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$302.71
|
|
|
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 |
$506.44 |
| Rate for Payer: Adventist Health Commercial |
$135.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$417.30
|
| 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 |
$337.76
|
| Rate for Payer: Blue Shield of California Commercial |
$411.90
|
| Rate for Payer: Blue Shield of California EPN |
$329.52
|
| 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 |
$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 |
$432.16
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.64
|
| Rate for Payer: Heritage Provider Network Senior |
$312.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$322.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$506.44
|
| Rate for Payer: TriValley Medical Group Commercial |
$270.10
|
| Rate for Payer: TriValley Medical Group Senior |
$270.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$243.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$223.58
|
| 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 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 |
$434.86
|
| Rate for Payer: Cash Price |
$303.86
|
| Rate for Payer: Cigna of CA HMO/PPO |
$310.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$312.64
|
| Rate for Payer: Heritage Provider Network Senior |
$312.64
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$243.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$223.58
|
|
|
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 |
$316.38
|
| 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 |
$227.46
|
| Rate for Payer: Heritage Provider Network Senior |
$227.46
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$177.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.66
|
|
|
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 |
$368.46 |
| Rate for Payer: Adventist Health Commercial |
$98.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$303.61
|
| 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 |
$245.74
|
| Rate for Payer: Blue Shield of California Commercial |
$299.68
|
| Rate for Payer: Blue Shield of California EPN |
$239.74
|
| 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 |
$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 |
$314.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$227.46
|
| Rate for Payer: Heritage Provider Network Senior |
$227.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$234.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$368.46
|
| Rate for Payer: TriValley Medical Group Commercial |
$196.51
|
| Rate for Payer: TriValley Medical Group Senior |
$196.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$177.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$162.66
|
| 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 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 |
$287.91 |
| Rate for Payer: Adventist Health Commercial |
$76.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$237.24
|
| 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 |
$192.02
|
| Rate for Payer: Blue Shield of California Commercial |
$234.17
|
| Rate for Payer: Blue Shield of California EPN |
$187.33
|
| 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 |
$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 |
$245.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$177.74
|
| Rate for Payer: Heritage Provider Network Senior |
$177.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$183.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$287.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$153.55
|
| Rate for Payer: TriValley Medical Group Senior |
$153.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$138.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$127.10
|
| 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
|
|
