|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
|
OP
|
$6,402.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,280.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,421.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,398.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$3,521.10
|
| Rate for Payer: Cash Price |
$3,521.10
|
| Rate for Payer: Cash Price |
$3,521.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,161.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Senior |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,324.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,334.15
|
| Rate for Payer: Heritage Provider Network Senior |
$4,334.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,053.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,158.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,600.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,928.52
|
| Rate for Payer: Multiplan Commercial |
$4,801.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,303.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,119.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC WOUND EXPLORATION TRAUMA EXTRE
|
Facility
|
IP
|
$2,929.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
900501282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$530.15 |
| Max. Negotiated Rate |
$2,196.75 |
| Rate for Payer: Adventist Health Commercial |
$585.80
|
| Rate for Payer: Cash Price |
$1,610.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,982.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,982.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.25
|
| Rate for Payer: Multiplan Commercial |
$2,196.75
|
|
|
HC WOUND EXPLORATION TRAUMA EXTRE
|
Facility
|
OP
|
$2,929.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
900501282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$585.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,012.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$1,610.95
|
| Rate for Payer: Cash Price |
$1,610.95
|
| Rate for Payer: Cash Price |
$1,610.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,903.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,982.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,982.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,397.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$2,196.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,053.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$969.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC WOUND MATRIX NEOX 100 2.0X2.0
|
Facility
|
IP
|
$684.25
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.85 |
| Max. Negotiated Rate |
$513.19 |
| Rate for Payer: Adventist Health Commercial |
$136.85
|
| Rate for Payer: Cash Price |
$376.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$314.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.81
|
| Rate for Payer: Heritage Provider Network Senior |
$316.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.06
|
| Rate for Payer: Multiplan Commercial |
$513.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$247.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.56
|
|
|
HC WOUND MATRIX NEOX 100 2.0X2.0
|
Facility
|
OP
|
$684.25
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$581.61 |
| Rate for Payer: Adventist Health Commercial |
$136.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$365.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.19
|
| Rate for Payer: Blue Shield of California Commercial |
$417.39
|
| Rate for Payer: Blue Shield of California EPN |
$333.91
|
| Rate for Payer: Cash Price |
$376.34
|
| Rate for Payer: Cash Price |
$376.34
|
| Rate for Payer: Cigna of CA HMO/PPO |
$314.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.61
|
| Rate for Payer: Dignity Health Senior |
$581.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.81
|
| Rate for Payer: Heritage Provider Network Senior |
$316.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$326.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.98
|
| Rate for Payer: Multiplan Commercial |
$513.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$273.70
|
| Rate for Payer: TriValley Medical Group Senior |
$273.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$247.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$581.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.61
|
| Rate for Payer: Vantage Medical Group Senior |
$581.61
|
|
|
HC WOUND MATRIX NEOX 100 3.0X3.0
|
Facility
|
OP
|
$508.56
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$432.28 |
| Rate for Payer: Adventist Health Commercial |
$101.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$271.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$432.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$279.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.42
|
| Rate for Payer: Blue Shield of California Commercial |
$310.22
|
| Rate for Payer: Blue Shield of California EPN |
$248.18
|
| Rate for Payer: Cash Price |
$279.71
|
| Rate for Payer: Cash Price |
$279.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$233.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$432.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$432.28
|
| Rate for Payer: Dignity Health Senior |
$432.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.46
|
| Rate for Payer: Heritage Provider Network Senior |
$235.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$242.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$355.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$355.99
|
| Rate for Payer: Multiplan Commercial |
$381.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$203.42
|
| Rate for Payer: TriValley Medical Group Senior |
$203.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$183.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$168.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$432.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$432.28
|
| Rate for Payer: Vantage Medical Group Senior |
$432.28
|
|
|
HC WOUND MATRIX NEOX 100 3.0X3.0
|
Facility
|
IP
|
$508.56
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.05 |
| Max. Negotiated Rate |
$381.42 |
| Rate for Payer: Adventist Health Commercial |
$101.71
|
| Rate for Payer: Cash Price |
$279.71
|
| Rate for Payer: Cigna of CA HMO/PPO |
$233.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.46
|
| Rate for Payer: Heritage Provider Network Senior |
$235.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.14
|
| Rate for Payer: Multiplan Commercial |
$381.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$183.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$168.38
|
|
|
HC WOUND MATRIX NEOX 100 4.0X4.0
|
Facility
|
IP
|
$322.59
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$241.94 |
| Rate for Payer: Adventist Health Commercial |
$64.52
|
| Rate for Payer: Cash Price |
$177.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.36
|
| Rate for Payer: Heritage Provider Network Senior |
$149.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.65
|
| Rate for Payer: Multiplan Commercial |
$241.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.81
|
|
|
HC WOUND MATRIX NEOX 100 4.0X4.0
|
Facility
|
OP
|
$322.59
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$274.20 |
| Rate for Payer: Adventist Health Commercial |
$64.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$172.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$221.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$274.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$177.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$241.94
|
| Rate for Payer: Blue Shield of California Commercial |
$196.78
|
| Rate for Payer: Blue Shield of California EPN |
$157.42
|
| Rate for Payer: Cash Price |
$177.42
|
| Rate for Payer: Cash Price |
$177.42
|
| Rate for Payer: Cigna of CA HMO/PPO |
$148.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$274.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$274.20
|
| Rate for Payer: Dignity Health Senior |
$274.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$149.36
|
| Rate for Payer: Heritage Provider Network Senior |
$149.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$153.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$225.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$225.81
|
| Rate for Payer: Multiplan Commercial |
$241.94
|
| Rate for Payer: TriValley Medical Group Commercial |
$129.04
|
| Rate for Payer: TriValley Medical Group Senior |
$129.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$116.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$106.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$274.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$274.20
|
| Rate for Payer: Vantage Medical Group Senior |
$274.20
|
|
|
HC WOUND MATRIX NEOX 100 7.0X7.0
|
Facility
|
IP
|
$218.60
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.57 |
| Max. Negotiated Rate |
$163.95 |
| Rate for Payer: Adventist Health Commercial |
$43.72
|
| Rate for Payer: Cash Price |
$120.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.21
|
| Rate for Payer: Heritage Provider Network Senior |
$101.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.65
|
| Rate for Payer: Multiplan Commercial |
$163.95
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$78.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$72.38
|
|
|
HC WOUND MATRIX NEOX 100 7.0X7.0
|
Facility
|
OP
|
$218.60
|
|
|
Service Code
|
CPT Q4156
|
| Hospital Charge Code |
900102194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.57 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Adventist Health Commercial |
$43.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$150.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.95
|
| Rate for Payer: Blue Shield of California Commercial |
$133.35
|
| Rate for Payer: Blue Shield of California EPN |
$106.68
|
| Rate for Payer: Cash Price |
$120.23
|
| Rate for Payer: Cash Price |
$120.23
|
| Rate for Payer: Cigna of CA HMO/PPO |
$100.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.81
|
| Rate for Payer: Dignity Health Senior |
$185.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.21
|
| Rate for Payer: Heritage Provider Network Senior |
$101.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$64.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$104.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$153.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$153.02
|
| Rate for Payer: Multiplan Commercial |
$163.95
|
| Rate for Payer: TriValley Medical Group Commercial |
$87.44
|
| Rate for Payer: TriValley Medical Group Senior |
$87.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$78.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$72.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.81
|
| Rate for Payer: Vantage Medical Group Senior |
$185.81
|
|
|
HC WOUND MATRIX NEOX FLO 100MG PARTICULATE
|
Facility
|
OP
|
$42.55
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$36.17 |
| Rate for Payer: Adventist Health Commercial |
$8.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.91
|
| Rate for Payer: Blue Shield of California Commercial |
$25.96
|
| Rate for Payer: Blue Shield of California EPN |
$20.76
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.17
|
| Rate for Payer: Dignity Health Senior |
$36.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.70
|
| Rate for Payer: Heritage Provider Network Senior |
$19.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$31.91
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.02
|
| Rate for Payer: TriValley Medical Group Senior |
$17.02
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.17
|
| Rate for Payer: Vantage Medical Group Senior |
$36.17
|
|
|
HC WOUND MATRIX NEOX FLO 100MG PARTICULATE
|
Facility
|
IP
|
$42.55
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$31.91 |
| Rate for Payer: Adventist Health Commercial |
$8.51
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.70
|
| Rate for Payer: Heritage Provider Network Senior |
$19.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.64
|
| Rate for Payer: Multiplan Commercial |
$31.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.09
|
|
|
HC WOUND MATRIX NEOX FLO 150MG PARTICULATE
|
Facility
|
OP
|
$41.81
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$35.54 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.36
|
| Rate for Payer: Blue Shield of California Commercial |
$25.50
|
| Rate for Payer: Blue Shield of California EPN |
$20.40
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.54
|
| Rate for Payer: Dignity Health Senior |
$35.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.36
|
| Rate for Payer: Heritage Provider Network Senior |
$19.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.27
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.72
|
| Rate for Payer: TriValley Medical Group Senior |
$16.72
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.54
|
| Rate for Payer: Vantage Medical Group Senior |
$35.54
|
|
|
HC WOUND MATRIX NEOX FLO 150MG PARTICULATE
|
Facility
|
IP
|
$41.81
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102215
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.36
|
| Rate for Payer: Heritage Provider Network Senior |
$19.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.84
|
|
|
HC WOUND MATRIX NEOX FLO 25MG PARTICULATE
|
Facility
|
OP
|
$84.80
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$72.08 |
| Rate for Payer: Adventist Health Commercial |
$16.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.60
|
| Rate for Payer: Blue Shield of California Commercial |
$51.73
|
| Rate for Payer: Blue Shield of California EPN |
$41.38
|
| Rate for Payer: Cash Price |
$46.64
|
| Rate for Payer: Cash Price |
$46.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.08
|
| Rate for Payer: Dignity Health Senior |
$72.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.26
|
| Rate for Payer: Heritage Provider Network Senior |
$39.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$40.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.36
|
| Rate for Payer: Multiplan Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial |
$33.92
|
| Rate for Payer: TriValley Medical Group Senior |
$33.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.08
|
| Rate for Payer: Vantage Medical Group Senior |
$72.08
|
|
|
HC WOUND MATRIX NEOX FLO 25MG PARTICULATE
|
Facility
|
IP
|
$84.80
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Adventist Health Commercial |
$16.96
|
| Rate for Payer: Cash Price |
$46.64
|
| Rate for Payer: Cigna of CA HMO/PPO |
$39.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.26
|
| Rate for Payer: Heritage Provider Network Senior |
$39.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$63.60
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$30.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.08
|
|
|
HC WOUND MATRIX NEOX FLO 50MG PARTICULATE
|
Facility
|
IP
|
$55.20
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Adventist Health Commercial |
$11.04
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.56
|
| Rate for Payer: Heritage Provider Network Senior |
$25.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.80
|
| Rate for Payer: Multiplan Commercial |
$41.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.28
|
|
|
HC WOUND MATRIX NEOX FLO 50MG PARTICULATE
|
Facility
|
OP
|
$55.20
|
|
|
Service Code
|
CPT Q4155
|
| Hospital Charge Code |
900102206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Adventist Health Commercial |
$11.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$29.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.40
|
| Rate for Payer: Blue Shield of California Commercial |
$33.67
|
| Rate for Payer: Blue Shield of California EPN |
$26.94
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.92
|
| Rate for Payer: Dignity Health Senior |
$46.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.56
|
| Rate for Payer: Heritage Provider Network Senior |
$25.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$41.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$22.08
|
| Rate for Payer: TriValley Medical Group Senior |
$22.08
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$19.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.92
|
| Rate for Payer: Vantage Medical Group Senior |
$46.92
|
|
|
HC WRIST ARTHROGRAPHY INJECT
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
909000115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$356.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$285.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$389.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$285.45
|
| Rate for Payer: Cash Price |
$285.45
|
| Rate for Payer: Cash Price |
$285.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$337.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$441.15
|
| Rate for Payer: Dignity Health Senior |
$441.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$321.26
|
| Rate for Payer: Heritage Provider Network Senior |
$321.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$294.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$247.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$363.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$363.30
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$441.15
|
| Rate for Payer: Vantage Medical Group Senior |
$441.15
|
|
|
HC WRIST ARTHROGRAPHY INJECT
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
909000115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.94 |
| Max. Negotiated Rate |
$389.25 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Cash Price |
$285.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.36
|
| Rate for Payer: Heritage Provider Network Senior |
$351.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.75
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
|
|
HC WRIST COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
909001210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.62 |
| Max. Negotiated Rate |
$512.25 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Cash Price |
$375.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$462.39
|
| Rate for Payer: Heritage Provider Network Senior |
$462.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.75
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
|
|
HC WRIST COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
909001210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.73 |
| Max. Negotiated Rate |
$512.25 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$365.06
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$469.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.54
|
| Rate for Payer: Blue Shield of California Commercial |
$109.97
|
| Rate for Payer: Blue Shield of California EPN |
$88.43
|
| Rate for Payer: Cash Price |
$375.65
|
| Rate for Payer: Cash Price |
$375.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$443.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$422.78
|
| Rate for Payer: Heritage Provider Network Senior |
$422.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$325.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC WRIST LIMITED
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
909001514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$310.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.83
|
| Rate for Payer: Blue Shield of California Commercial |
$101.86
|
| Rate for Payer: Blue Shield of California EPN |
$81.91
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$377.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$359.02
|
| Rate for Payer: Heritage Provider Network Senior |
$359.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$276.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC WRIST LIMITED
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
909001514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
|
