|
HC IMPL DRSNG OASIS WND MATRIX 3X3.5CM
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101458
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$37.41
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$48.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Blue Shield of California Commercial |
$42.70
|
| Rate for Payer: Blue Shield of California EPN |
$34.16
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Senior |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.41
|
| Rate for Payer: Heritage Provider Network Senior |
$32.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$33.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$28.00
|
| Rate for Payer: TriValley Medical Group Senior |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X3.5CM
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101458
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.41
|
| Rate for Payer: Heritage Provider Network Senior |
$32.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$25.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$23.18
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X7CM
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.50
|
| Rate for Payer: Blue Shield of California Commercial |
$45.14
|
| Rate for Payer: Blue Shield of California EPN |
$36.11
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.90
|
| Rate for Payer: Dignity Health Senior |
$62.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.26
|
| Rate for Payer: Heritage Provider Network Senior |
$34.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$35.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.80
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$29.60
|
| Rate for Payer: TriValley Medical Group Senior |
$29.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.90
|
| Rate for Payer: Vantage Medical Group Senior |
$62.90
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X7CM
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$55.50 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$40.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.26
|
| Rate for Payer: Heritage Provider Network Senior |
$34.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$26.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$24.50
|
|
|
HC IMPL GORE SEPTAL OCCL DEVICE
|
Facility
|
IP
|
$13,780.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$2,756.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,614.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,539.56
|
| Rate for Payer: Blue Shield of California EPN |
$5,539.56
|
| Rate for Payer: Cash Price |
$7,579.00
|
| Rate for Payer: Cash Price |
$7,579.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,338.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,441.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,380.14
|
| Rate for Payer: Heritage Provider Network Senior |
$6,380.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,890.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,890.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,890.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,445.00
|
| Rate for Payer: Multiplan Commercial |
$10,335.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,978.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,562.56
|
|
|
HC IMPL GORE SEPTAL OCCL DEVICE
|
Facility
|
OP
|
$13,780.00
|
|
|
Service Code
|
CPT C1817
|
| Hospital Charge Code |
906812357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$2,756.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,614.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,466.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,713.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,579.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,335.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,539.56
|
| Rate for Payer: Blue Shield of California EPN |
$5,539.56
|
| Rate for Payer: Cash Price |
$7,579.00
|
| Rate for Payer: Cash Price |
$7,579.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,338.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,713.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,713.00
|
| Rate for Payer: Dignity Health Senior |
$11,713.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,819.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,380.14
|
| Rate for Payer: Heritage Provider Network Senior |
$6,380.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,890.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,890.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,890.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,445.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,646.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,646.00
|
| Rate for Payer: Multiplan Commercial |
$10,335.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,978.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,562.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,713.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,713.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11,713.00
|
|
|
HC IMPL GRAFIX CORE 2 X 3 CM 6 UNITS
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
900101532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.72 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Adventist Health Commercial |
$135.60
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$311.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$313.91
|
| Rate for Payer: Heritage Provider Network Senior |
$313.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.50
|
| Rate for Payer: Multiplan Commercial |
$508.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$244.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$224.49
|
|
|
HC IMPL GRAFIX CORE 2 X 3 CM 6 UNITS
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
900101532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$576.30 |
| Rate for Payer: Adventist Health Commercial |
$135.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$362.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$465.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$576.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$372.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$508.50
|
| Rate for Payer: Blue Shield of California Commercial |
$413.58
|
| Rate for Payer: Blue Shield of California EPN |
$330.86
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$311.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$576.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$576.30
|
| Rate for Payer: Dignity Health Senior |
$576.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$433.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$313.91
|
| Rate for Payer: Heritage Provider Network Senior |
$313.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$323.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$474.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$474.60
|
| Rate for Payer: Multiplan Commercial |
$508.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$244.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$224.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$576.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$576.30
|
| Rate for Payer: Vantage Medical Group Senior |
$576.30
|
|
|
HC IMPL GRAFIX PL PRIME 1.5X2CM
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900103301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.37 |
| Max. Negotiated Rate |
$1,031.90 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$648.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$834.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$667.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.50
|
| Rate for Payer: Blue Shield of California Commercial |
$740.54
|
| Rate for Payer: Blue Shield of California EPN |
$592.43
|
| Rate for Payer: Cash Price |
$667.70
|
| Rate for Payer: Cash Price |
$667.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$558.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,031.90
|
| Rate for Payer: Dignity Health Senior |
$1,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$776.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$562.08
|
| Rate for Payer: Heritage Provider Network Senior |
$562.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$579.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$849.80
|
| Rate for Payer: Multiplan Commercial |
$910.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$485.60
|
| Rate for Payer: TriValley Medical Group Senior |
$485.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$438.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$401.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,031.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,031.90
|
|
|
HC IMPL GRAFIX PL PRIME 1.5X2CM
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900103301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.73 |
| Max. Negotiated Rate |
$910.50 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Cash Price |
$667.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$558.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$655.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$562.08
|
| Rate for Payer: Heritage Provider Network Senior |
$562.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.50
|
| Rate for Payer: Multiplan Commercial |
$910.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$438.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$401.96
|
|
|
HC IMPL GRAFIX PL PRIME 2X3 CM
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900103304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.87 |
| Max. Negotiated Rate |
$534.00 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Cash Price |
$391.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$327.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.66
|
| Rate for Payer: Heritage Provider Network Senior |
$329.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.00
|
| Rate for Payer: Multiplan Commercial |
$534.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$257.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$235.74
|
|
|
HC IMPL GRAFIX PL PRIME 2X3 CM
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900103304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.87 |
| Max. Negotiated Rate |
$605.20 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$380.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$489.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$534.00
|
| Rate for Payer: Blue Shield of California Commercial |
$434.32
|
| Rate for Payer: Blue Shield of California EPN |
$347.46
|
| Rate for Payer: Cash Price |
$391.60
|
| Rate for Payer: Cash Price |
$391.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$327.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$605.20
|
| Rate for Payer: Dignity Health Senior |
$605.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$329.66
|
| Rate for Payer: Heritage Provider Network Senior |
$329.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$339.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.40
|
| Rate for Payer: Multiplan Commercial |
$534.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$284.80
|
| Rate for Payer: TriValley Medical Group Senior |
$284.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$257.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$235.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$605.20
|
| Rate for Payer: Vantage Medical Group Senior |
$605.20
|
|
|
HC IMPL GRAFIX PL PRIME 3X3CM
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900103300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.62 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Adventist Health Commercial |
$92.40
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$212.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.91
|
| Rate for Payer: Heritage Provider Network Senior |
$213.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$346.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$166.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$152.97
|
|
|
HC IMPL GRAFIX PL PRIME 3X3CM
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900103300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.62 |
| Max. Negotiated Rate |
$392.70 |
| Rate for Payer: Adventist Health Commercial |
$92.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$246.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$317.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$392.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$254.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$346.50
|
| Rate for Payer: Blue Shield of California Commercial |
$281.82
|
| Rate for Payer: Blue Shield of California EPN |
$225.46
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$212.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$392.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$392.70
|
| Rate for Payer: Dignity Health Senior |
$392.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$295.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.91
|
| Rate for Payer: Heritage Provider Network Senior |
$213.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$220.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$323.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$323.40
|
| Rate for Payer: Multiplan Commercial |
$346.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$184.80
|
| Rate for Payer: TriValley Medical Group Senior |
$184.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$166.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$152.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$392.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$392.70
|
| Rate for Payer: Vantage Medical Group Senior |
$392.70
|
|
|
HC IMPL GRAFIX PRIME 2 X 3 CM 6 UNITS
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101533
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.36 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$155.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$156.96
|
| Rate for Payer: Heritage Provider Network Senior |
$156.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.75
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$122.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$112.24
|
|
|
HC IMPL GRAFIX PRIME 2 X 3 CM 6 UNITS
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101533
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.36 |
| Max. Negotiated Rate |
$288.15 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$181.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$232.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Blue Shield of California Commercial |
$206.79
|
| Rate for Payer: Blue Shield of California EPN |
$165.43
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$155.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Senior |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$156.96
|
| Rate for Payer: Heritage Provider Network Senior |
$156.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$161.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.60
|
| Rate for Payer: TriValley Medical Group Senior |
$135.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$122.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$112.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC IMPL GRAFT DERMAGRAFT 5CM X 7.5CM
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT Q4106
|
| Hospital Charge Code |
900101460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$71.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$91.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.75
|
| Rate for Payer: Blue Shield of California Commercial |
$81.13
|
| Rate for Payer: Blue Shield of California EPN |
$64.90
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.05
|
| Rate for Payer: Dignity Health Senior |
$113.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.58
|
| Rate for Payer: Heritage Provider Network Senior |
$61.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$63.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.10
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$53.20
|
| Rate for Payer: TriValley Medical Group Senior |
$53.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.05
|
| Rate for Payer: Vantage Medical Group Senior |
$113.05
|
|
|
HC IMPL GRAFT DERMAGRAFT 5CM X 7.5CM
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT Q4106
|
| Hospital Charge Code |
900101460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.58
|
| Rate for Payer: Heritage Provider Network Senior |
$61.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$48.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.04
|
|
|
HC IMPL GRAFT EPIFIX 14MM DISK
|
Facility
|
IP
|
$829.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.05 |
| Max. Negotiated Rate |
$621.75 |
| Rate for Payer: Adventist Health Commercial |
$165.80
|
| Rate for Payer: Cash Price |
$455.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$381.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.83
|
| Rate for Payer: Heritage Provider Network Senior |
$383.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.25
|
| Rate for Payer: Multiplan Commercial |
$621.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$299.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$274.48
|
|
|
HC IMPL GRAFT EPIFIX 14MM DISK
|
Facility
|
OP
|
$829.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.05 |
| Max. Negotiated Rate |
$704.65 |
| Rate for Payer: Adventist Health Commercial |
$165.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$443.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$569.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$704.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$621.75
|
| Rate for Payer: Blue Shield of California Commercial |
$505.69
|
| Rate for Payer: Blue Shield of California EPN |
$404.55
|
| Rate for Payer: Cash Price |
$455.95
|
| Rate for Payer: Cash Price |
$455.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$381.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$704.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$704.65
|
| Rate for Payer: Dignity Health Senior |
$704.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$383.83
|
| Rate for Payer: Heritage Provider Network Senior |
$383.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$395.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$580.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$580.30
|
| Rate for Payer: Multiplan Commercial |
$621.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$331.60
|
| Rate for Payer: TriValley Medical Group Senior |
$331.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$299.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$274.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$704.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$704.65
|
| Rate for Payer: Vantage Medical Group Senior |
$704.65
|
|
|
HC IMPL GRAFT EPIFIX 18MM DISK
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.33 |
| Max. Negotiated Rate |
$610.50 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Cash Price |
$447.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$374.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.88
|
| Rate for Payer: Heritage Provider Network Senior |
$376.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.50
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$269.52
|
|
|
HC IMPL GRAFT EPIFIX 18MM DISK
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.33 |
| Max. Negotiated Rate |
$691.90 |
| Rate for Payer: Adventist Health Commercial |
$162.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$435.08
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$559.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$447.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$610.50
|
| Rate for Payer: Blue Shield of California Commercial |
$496.54
|
| Rate for Payer: Blue Shield of California EPN |
$397.23
|
| Rate for Payer: Cash Price |
$447.70
|
| Rate for Payer: Cash Price |
$447.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$374.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$691.90
|
| Rate for Payer: Dignity Health Senior |
$691.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$520.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.88
|
| Rate for Payer: Heritage Provider Network Senior |
$376.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$388.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$569.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.80
|
| Rate for Payer: Multiplan Commercial |
$610.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$325.60
|
| Rate for Payer: TriValley Medical Group Senior |
$325.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$269.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$691.90
|
| Rate for Payer: Vantage Medical Group Senior |
$691.90
|
|
|
HC IMPL GRAFT EPIFIX 2X2 CM
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.33 |
| Max. Negotiated Rate |
$837.25 |
| Rate for Payer: Adventist Health Commercial |
$197.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$526.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$676.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$837.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$541.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$738.75
|
| Rate for Payer: Blue Shield of California Commercial |
$600.85
|
| Rate for Payer: Blue Shield of California EPN |
$480.68
|
| Rate for Payer: Cash Price |
$541.75
|
| Rate for Payer: Cash Price |
$541.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$453.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$837.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$837.25
|
| Rate for Payer: Dignity Health Senior |
$837.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$630.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.06
|
| Rate for Payer: Heritage Provider Network Senior |
$456.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$469.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$689.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$689.50
|
| Rate for Payer: Multiplan Commercial |
$738.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$394.00
|
| Rate for Payer: TriValley Medical Group Senior |
$394.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$355.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$326.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$837.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$837.25
|
| Rate for Payer: Vantage Medical Group Senior |
$837.25
|
|
|
HC IMPL GRAFT EPIFIX 2X2 CM
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$178.28 |
| Max. Negotiated Rate |
$738.75 |
| Rate for Payer: Adventist Health Commercial |
$197.00
|
| Rate for Payer: Cash Price |
$541.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$453.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.06
|
| Rate for Payer: Heritage Provider Network Senior |
$456.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.25
|
| Rate for Payer: Multiplan Commercial |
$738.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$355.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$326.13
|
|
|
HC IMPL GRAFT EPIFIX 2X4 CM
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$333.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$530.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$343.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$468.00
|
| Rate for Payer: Blue Shield of California Commercial |
$380.64
|
| Rate for Payer: Blue Shield of California EPN |
$304.51
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$287.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$530.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$530.40
|
| Rate for Payer: Dignity Health Senior |
$530.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$399.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$288.91
|
| Rate for Payer: Heritage Provider Network Senior |
$288.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$297.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$436.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$436.80
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$249.60
|
| Rate for Payer: TriValley Medical Group Senior |
$249.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$225.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$206.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$530.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$530.40
|
| Rate for Payer: Vantage Medical Group Senior |
$530.40
|
|
