|
HC IMPL GRAFT EPIFIX 2X4 CM
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$287.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$288.91
|
| Rate for Payer: Heritage Provider Network Senior |
$288.91
|
| 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: Multiplan Commercial |
$468.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$225.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$206.61
|
|
|
HC IMPL GRAFT EPIFIX 3X4 CM
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.85 |
| Max. Negotiated Rate |
$550.50 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$337.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$339.84
|
| Rate for Payer: Heritage Provider Network Senior |
$339.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.50
|
| Rate for Payer: Multiplan Commercial |
$550.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$265.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.03
|
|
|
HC IMPL GRAFT EPIFIX 3X4 CM
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.85 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: Adventist Health Commercial |
$146.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$392.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$504.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$623.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$403.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$550.50
|
| Rate for Payer: Blue Shield of California Commercial |
$447.74
|
| Rate for Payer: Blue Shield of California EPN |
$358.19
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: Cash Price |
$403.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$337.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$623.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$623.90
|
| Rate for Payer: Dignity Health Senior |
$623.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$339.84
|
| Rate for Payer: Heritage Provider Network Senior |
$339.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$350.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$513.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$513.80
|
| Rate for Payer: Multiplan Commercial |
$550.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$293.60
|
| Rate for Payer: TriValley Medical Group Senior |
$293.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$265.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$243.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$623.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$623.90
|
| Rate for Payer: Vantage Medical Group Senior |
$623.90
|
|
|
HC IMPL GRAFT EPIFIX 4X4.5 CM MESH
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101528
|
|
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 4X4.5 CM MESH
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101528
|
|
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 4X4 CM
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.67 |
| Max. Negotiated Rate |
$623.05 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$391.79
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$503.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$623.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$403.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$549.75
|
| Rate for Payer: Blue Shield of California Commercial |
$447.13
|
| Rate for Payer: Blue Shield of California EPN |
$357.70
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$337.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$623.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$623.05
|
| Rate for Payer: Dignity Health Senior |
$623.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$339.38
|
| Rate for Payer: Heritage Provider Network Senior |
$339.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$349.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$513.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$513.10
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$293.20
|
| Rate for Payer: TriValley Medical Group Senior |
$293.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$264.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$242.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$623.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$623.05
|
| Rate for Payer: Vantage Medical Group Senior |
$623.05
|
|
|
HC IMPL GRAFT EPIFIX 4X4 CM
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101530
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.67 |
| Max. Negotiated Rate |
$549.75 |
| Rate for Payer: Adventist Health Commercial |
$146.60
|
| Rate for Payer: Cash Price |
$403.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$337.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$395.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$339.38
|
| Rate for Payer: Heritage Provider Network Senior |
$339.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.25
|
| Rate for Payer: Multiplan Commercial |
$549.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$264.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$242.70
|
|
|
HC IMPL GRAFT EPIFIX 5X6 CM
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.94 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$395.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$508.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.00
|
| Rate for Payer: Blue Shield of California Commercial |
$451.40
|
| Rate for Payer: Blue Shield of California EPN |
$361.12
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$340.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$629.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$629.00
|
| Rate for Payer: Dignity Health Senior |
$629.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.62
|
| Rate for Payer: Heritage Provider Network Senior |
$342.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$352.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$518.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$518.00
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$296.00
|
| Rate for Payer: TriValley Medical Group Senior |
$296.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$267.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$245.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$629.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$629.00
|
| Rate for Payer: Vantage Medical Group Senior |
$629.00
|
|
|
HC IMPL GRAFT EPIFIX 5X6 CM
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101531
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.94 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$340.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$399.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$342.62
|
| Rate for Payer: Heritage Provider Network Senior |
$342.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$267.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$245.01
|
|
|
HC IMPL MED REVEAL ACT 6190
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$218.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$313.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$342.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$183.31
|
| Rate for Payer: Blue Shield of California EPN |
$183.31
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$387.60
|
| Rate for Payer: Dignity Health Senior |
$387.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.13
|
| Rate for Payer: Heritage Provider Network Senior |
$211.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$228.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$319.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$319.20
|
| Rate for Payer: Multiplan Commercial |
$342.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$150.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$387.60
|
| Rate for Payer: Vantage Medical Group Senior |
$387.60
|
|
|
HC IMPL MED REVEAL ACT 6190
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$218.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$183.31
|
| Rate for Payer: Blue Shield of California EPN |
$183.31
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$209.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$211.13
|
| Rate for Payer: Heritage Provider Network Senior |
$211.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$228.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$342.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$150.98
|
|
|
HC IMPL MED REVEAL DX 9528
|
Facility
|
IP
|
$9,987.50
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,997.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,997.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,794.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,014.97
|
| Rate for Payer: Blue Shield of California EPN |
$4,014.97
|
| Rate for Payer: Cash Price |
$5,493.12
|
| Rate for Payer: Cash Price |
$5,493.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,594.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,393.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,624.21
|
| Rate for Payer: Heritage Provider Network Senior |
$4,624.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,993.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,993.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,993.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,496.88
|
| Rate for Payer: Multiplan Commercial |
$7,490.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,608.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,306.86
|
|
|
HC IMPL MED REVEAL DX 9528
|
Facility
|
OP
|
$9,987.50
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813619
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,997.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,997.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,794.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,861.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,489.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,493.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,490.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,014.97
|
| Rate for Payer: Blue Shield of California EPN |
$4,014.97
|
| Rate for Payer: Cash Price |
$5,493.12
|
| Rate for Payer: Cash Price |
$5,493.12
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,594.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,489.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,489.38
|
| Rate for Payer: Dignity Health Senior |
$8,489.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,392.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,624.21
|
| Rate for Payer: Heritage Provider Network Senior |
$4,624.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,993.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,993.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,993.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,496.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,991.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,991.25
|
| Rate for Payer: Multiplan Commercial |
$7,490.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,608.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,306.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,489.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,489.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,489.38
|
|
|
HC IMPL MED REVEAL XT 9529
|
Facility
|
IP
|
$10,987.50
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,197.50 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$2,197.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,274.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,416.98
|
| Rate for Payer: Blue Shield of California EPN |
$4,416.98
|
| Rate for Payer: Cash Price |
$6,043.13
|
| Rate for Payer: Cash Price |
$6,043.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,054.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,933.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,087.21
|
| Rate for Payer: Heritage Provider Network Senior |
$5,087.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,493.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,493.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,493.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,746.88
|
| Rate for Payer: Multiplan Commercial |
$8,240.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,969.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,637.96
|
|
|
HC IMPL MED REVEAL XT 9529
|
Facility
|
OP
|
$10,987.50
|
|
|
Service Code
|
CPT C1764
|
| Hospital Charge Code |
906813636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,197.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$2,197.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,274.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,548.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,339.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,043.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,240.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,416.98
|
| Rate for Payer: Blue Shield of California EPN |
$4,416.98
|
| Rate for Payer: Cash Price |
$6,043.13
|
| Rate for Payer: Cash Price |
$6,043.13
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,054.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,339.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,339.38
|
| Rate for Payer: Dignity Health Senior |
$9,339.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,032.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,087.21
|
| Rate for Payer: Heritage Provider Network Senior |
$5,087.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,493.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,493.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,493.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,746.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,691.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,691.25
|
| Rate for Payer: Multiplan Commercial |
$8,240.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,969.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,637.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,339.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,339.38
|
| Rate for Payer: Vantage Medical Group Senior |
$9,339.38
|
|
|
HC IMPL PRIMATRIX 3CM X 3CM MESH
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900103303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.01 |
| Max. Negotiated Rate |
$277.10 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$174.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$223.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$244.50
|
| Rate for Payer: Blue Shield of California Commercial |
$198.86
|
| Rate for Payer: Blue Shield of California EPN |
$159.09
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$149.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.10
|
| Rate for Payer: Dignity Health Senior |
$277.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.94
|
| Rate for Payer: Heritage Provider Network Senior |
$150.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$155.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.20
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$130.40
|
| Rate for Payer: TriValley Medical Group Senior |
$130.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$117.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$107.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.10
|
| Rate for Payer: Vantage Medical Group Senior |
$277.10
|
|
|
HC IMPL PRIMATRIX 3CM X 3CM MESH
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900103303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.01 |
| Max. Negotiated Rate |
$244.50 |
| Rate for Payer: Adventist Health Commercial |
$65.20
|
| Rate for Payer: Cash Price |
$179.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$149.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$150.94
|
| Rate for Payer: Heritage Provider Network Senior |
$150.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.50
|
| Rate for Payer: Multiplan Commercial |
$244.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$117.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$107.94
|
|
|
HC IMPL PRIMATRIX 4CM X 4CM MESH
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.23
|
| Rate for Payer: Heritage Provider Network Senior |
$72.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$56.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.65
|
|
|
HC IMPL PRIMATRIX 4CM X 4CM MESH
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$83.38
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Blue Shield of California Commercial |
$95.16
|
| Rate for Payer: Blue Shield of California EPN |
$76.13
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$71.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Senior |
$132.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$72.23
|
| Rate for Payer: Heritage Provider Network Senior |
$72.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.40
|
| Rate for Payer: TriValley Medical Group Senior |
$62.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$56.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$51.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
|
HC IMPL PRIMATRIX 5CM X 5CM MESH
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$155.55 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$97.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$125.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.25
|
| Rate for Payer: Blue Shield of California Commercial |
$111.63
|
| Rate for Payer: Blue Shield of California EPN |
$89.30
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.55
|
| Rate for Payer: Dignity Health Senior |
$155.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.73
|
| Rate for Payer: Heritage Provider Network Senior |
$84.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$87.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.10
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.55
|
| Rate for Payer: Vantage Medical Group Senior |
$155.55
|
|
|
HC IMPL PRIMATRIX 5CM X 5CM MESH
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$137.25 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Cash Price |
$100.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$84.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.73
|
| Rate for Payer: Heritage Provider Network Senior |
$84.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.75
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$66.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$60.59
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM FENESTRATED
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.50
|
| Rate for Payer: Blue Shield of California Commercial |
$76.86
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.10
|
| Rate for Payer: Dignity Health Senior |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.34
|
| Rate for Payer: Heritage Provider Network Senior |
$58.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.10
|
| Rate for Payer: Vantage Medical Group Senior |
$107.10
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM FENESTRATED
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.34
|
| Rate for Payer: Heritage Provider Network Senior |
$58.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.72
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM MESH
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.50
|
| Rate for Payer: Blue Shield of California Commercial |
$76.86
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.10
|
| Rate for Payer: Dignity Health Senior |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.34
|
| Rate for Payer: Heritage Provider Network Senior |
$58.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.10
|
| Rate for Payer: Vantage Medical Group Senior |
$107.10
|
|
|
HC IMPL PRIMATRIX 6CM X 6CM MESH
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT Q4110
|
| Hospital Charge Code |
900101520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$57.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.34
|
| Rate for Payer: Heritage Provider Network Senior |
$58.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$45.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.72
|
|
