|
HC IMPL DRESSING WOUND 3X7CM OASIS ULTRA
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT Q4124
|
| Hospital Charge Code |
900104053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$240.09 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.59
|
| 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 |
$4.87
|
| Rate for Payer: Blue Shield of California Commercial |
$46.97
|
| Rate for Payer: Blue Shield of California EPN |
$37.58
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.42
|
| 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 |
$49.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.65
|
| Rate for Payer: Heritage Provider Network Senior |
$35.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$30.80
|
| Rate for Payer: TriValley Medical Group Senior |
$30.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.49
|
| 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 IMPL DRESSING WOUND 3X7CM OASIS ULTRA
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT Q4124
|
| Hospital Charge Code |
900104053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.59
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.65
|
| Rate for Payer: Heritage Provider Network Senior |
$35.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.82
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$25.49
|
|
|
HC IMPL DRESSING WOUND 5X7CM OASIS ULTRA
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT Q4124
|
| Hospital Charge Code |
900101468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$57.96
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
|
|
HC IMPL DRESSING WOUND 5X7CM OASIS ULTRA
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT Q4124
|
| Hospital Charge Code |
900101468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$240.09 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$55.62
|
| 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 |
$4.87
|
| Rate for Payer: Blue Shield of California Commercial |
$54.90
|
| Rate for Payer: Blue Shield of California EPN |
$43.92
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| 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 |
$57.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.80
|
| 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 IMPL DRSNG OASIS WND MATRIX 3X3.5CM
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$28.14
|
| Rate for Payer: Blue Shield of California EPN |
$28.14
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| 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 Foundation Hospitals Commercial |
$35.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.00
|
| 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 3X3.5CM
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101458
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$43.26
|
| 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 |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$28.14
|
| Rate for Payer: Blue Shield of California EPN |
$28.14
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.20
|
| 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 |
$44.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| 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) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$35.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$176.07
|
| Rate for Payer: TriValley Medical Group Senior |
$160.06
|
| 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 |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X7CM
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$45.73
|
| 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 |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.75
|
| Rate for Payer: Blue Shield of California EPN |
$29.75
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34.04
|
| 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 |
$47.36
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| 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) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$37.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$176.07
|
| Rate for Payer: TriValley Medical Group Senior |
$160.06
|
| 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 |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
HC IMPL DRSNG OASIS WND MATRIX 3X7CM
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT Q4102
|
| Hospital Charge Code |
900101459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.75
|
| Rate for Payer: Blue Shield of California EPN |
$29.75
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| 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 Foundation Hospitals Commercial |
$37.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.00
|
| 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$2,756.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,874.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$6,201.00
|
| Rate for Payer: Cash Price |
$6,201.00
|
| 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 Foundation Hospitals Commercial |
$6,890.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,890.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$2,756.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,516.04
|
| 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 |
$13,770.00
|
| 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 |
$6,201.00
|
| Rate for Payer: Cash Price |
$6,201.00
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$6,890.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,890.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
OP
|
$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: Aetna of CA Non-Gatekeeper |
$419.00
|
| 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 |
$356.51
|
| 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 |
$305.10
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$311.88
|
| 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 |
$433.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| 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) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$323.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| 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 |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
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: Aetna of CA Non-Gatekeeper |
$436.63
|
| Rate for Payer: Cash Price |
$305.10
|
| 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 Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$781.82
|
| Rate for Payer: Cash Price |
$546.30
|
| 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 Foundation Hospitals 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 1.5X2CM
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900103301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$910.50 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$750.25
|
| 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 |
$356.51
|
| 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 |
$546.30
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$558.44
|
| 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 |
$776.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| 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) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$579.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| 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 |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
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 |
$534.00 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$440.02
|
| 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 |
$356.51
|
| 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 |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$327.52
|
| 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 |
$455.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| 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) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$339.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| 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 |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
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: Aetna of CA Non-Gatekeeper |
$458.53
|
| Rate for Payer: Cash Price |
$320.40
|
| 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 Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$297.53
|
| Rate for Payer: Cash Price |
$207.90
|
| 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 Foundation Hospitals 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 |
$356.51 |
| Rate for Payer: Adventist Health Commercial |
$92.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$285.52
|
| 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 |
$356.51
|
| 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 |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$212.52
|
| 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 |
$295.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| 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) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$220.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| 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 |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
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 |
$356.51 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$209.50
|
| 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 |
$356.51
|
| 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 |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$155.94
|
| 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 |
$216.96
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| 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) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$161.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| 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 |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
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: Aetna of CA Non-Gatekeeper |
$218.32
|
| Rate for Payer: Cash Price |
$152.55
|
| 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 Foundation Hospitals 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 GRAFT EPIFIX 14MM DISK
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$707.25 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$582.77
|
| 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 |
$471.69
|
| Rate for Payer: Blue Shield of California Commercial |
$575.23
|
| Rate for Payer: Blue Shield of California EPN |
$460.18
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$433.78
|
| 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 |
$603.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$436.61
|
| Rate for Payer: Heritage Provider Network Senior |
$436.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$449.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$707.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$377.20
|
| Rate for Payer: TriValley Medical Group Senior |
$377.20
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$340.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.23
|
| 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 IMPL GRAFT EPIFIX 14MM DISK
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.68 |
| Max. Negotiated Rate |
$707.25 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$607.29
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$433.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$509.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$436.61
|
| Rate for Payer: Heritage Provider Network Senior |
$436.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.75
|
| Rate for Payer: Multiplan Commercial |
$707.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$340.71
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.23
|
|
|
HC IMPL GRAFT EPIFIX 18MM DISK
|
Facility
|
OP
|
$1,415.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$1,061.25 |
| Rate for Payer: Adventist Health Commercial |
$283.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$874.47
|
| 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 |
$707.78
|
| Rate for Payer: Blue Shield of California Commercial |
$863.15
|
| Rate for Payer: Blue Shield of California EPN |
$690.52
|
| Rate for Payer: Cash Price |
$636.75
|
| Rate for Payer: Cash Price |
$636.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$650.90
|
| 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 |
$905.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$655.14
|
| Rate for Payer: Heritage Provider Network Senior |
$655.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$674.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$256.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$1,061.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.00
|
| Rate for Payer: TriValley Medical Group Senior |
$566.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$511.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$468.51
|
| 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 IMPL GRAFT EPIFIX 18MM DISK
|
Facility
|
IP
|
$1,415.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101525
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$256.12 |
| Max. Negotiated Rate |
$1,061.25 |
| Rate for Payer: Adventist Health Commercial |
$283.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$911.26
|
| Rate for Payer: Cash Price |
$636.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$650.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$764.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$655.14
|
| Rate for Payer: Heritage Provider Network Senior |
$655.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$256.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.75
|
| Rate for Payer: Multiplan Commercial |
$1,061.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$511.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$468.51
|
|
|
HC IMPL GRAFT EPIFIX 2X2 CM
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT Q4186
|
| Hospital Charge Code |
900101526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$94.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$291.70
|
| 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 |
$236.09
|
| Rate for Payer: Blue Shield of California Commercial |
$287.92
|
| Rate for Payer: Blue Shield of California EPN |
$230.34
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cash Price |
$212.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.12
|
| 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 |
$302.08
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$218.54
|
| Rate for Payer: Heritage Provider Network Senior |
$218.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$225.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$354.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$188.80
|
| Rate for Payer: TriValley Medical Group Senior |
$188.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$170.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$156.28
|
| 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
|
|
