|
HC WHIRLPOOL MCARE COM
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Senior |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.89
|
| Rate for Payer: Heritage Provider Network Senior |
$165.89
|
| Rate for Payer: IEHP Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$129.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC WHIRLPOOL OT
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
903207022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Senior |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.89
|
| Rate for Payer: Heritage Provider Network Senior |
$165.89
|
| Rate for Payer: IEHP Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$129.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC WHIRLPOOL OT
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
903207022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.44
|
| Rate for Payer: Heritage Provider Network Senior |
$181.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
|
|
HC WHIRLPOOL PT
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900419063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Senior |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.89
|
| Rate for Payer: Heritage Provider Network Senior |
$165.89
|
| Rate for Payer: IEHP Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$129.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC WHIRLPOOL PT
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900419063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.44
|
| Rate for Payer: Heritage Provider Network Senior |
$181.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
|
|
HC WHIRLPOOL PT
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
905103118
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Senior |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.89
|
| Rate for Payer: Heritage Provider Network Senior |
$165.89
|
| Rate for Payer: IEHP Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$129.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC WHIRLPOOL PT
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
905103118
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.44
|
| Rate for Payer: Heritage Provider Network Senior |
$181.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
|
|
HC WHITAKER TEST
|
Facility
OP
|
$2,233.00
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
909000169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$446.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,534.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$853.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,004.85
|
| Rate for Payer: Cash Price |
$1,004.85
|
| Rate for Payer: Cash Price |
$1,004.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,451.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.85
|
| Rate for Payer: Dignity Health Senior |
$853.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$853.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,382.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,049.80
|
| Rate for Payer: Humana Medicare |
$853.50
|
| Rate for Payer: IEHP Medi-Cal |
$71.43
|
| Rate for Payer: IEHP Medicare Advantage |
$853.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,621.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$404.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,007.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,075.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.41
|
| Rate for Payer: Multiplan Commercial |
$1,674.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$938.85
|
| Rate for Payer: TriValley Medical Group Senior |
$938.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,280.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.85
|
| Rate for Payer: Vantage Medical Group Senior |
$853.50
|
|
|
HC WHITAKER TEST
|
Facility
IP
|
$2,233.00
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
909000169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$404.17 |
| Max. Negotiated Rate |
$1,674.75 |
| Rate for Payer: Adventist Health Commercial |
$446.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,534.07
|
| Rate for Payer: Cash Price |
$1,004.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,511.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,511.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$404.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.25
|
| Rate for Payer: Multiplan Commercial |
$1,674.75
|
|
|
HC WHITE CAP 15MM
|
Facility
IP
|
$44.69
|
|
| Hospital Charge Code |
900800856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.70
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.26
|
| Rate for Payer: Heritage Provider Network Senior |
$30.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.17
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
|
|
HC WHITE CAP 15MM
|
Facility
OP
|
$44.69
|
|
| Hospital Charge Code |
900800856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$33.52
|
| Rate for Payer: Blue Shield of California Commercial |
$27.75
|
| Rate for Payer: Blue Shield of California EPN |
$26.23
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.99
|
| Rate for Payer: Dignity Health Senior |
$37.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.66
|
| Rate for Payer: Heritage Provider Network Senior |
$27.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.17
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.99
|
| Rate for Payer: Vantage Medical Group Senior |
$37.99
|
|
|
HC WINDOWING OF CAST
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$92.57
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: Dignity Health Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$196.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Humana Medicare |
$196.87
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$196.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$232.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.06
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$197.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$181.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC WINDOWING OF CAST
|
Facility
IP
|
$543.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$407.25 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
|
|
HC WIRE INDIGO SEPERATOR
|
Facility
OP
|
$2,913.00
|
|
|
Service Code
|
CPT C1759
|
| Hospital Charge Code |
909000017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,398.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,476.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,602.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,184.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,808.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,709.93
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,339.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,476.05
|
| Rate for Payer: Dignity Health Senior |
$2,476.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,864.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,348.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,348.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,456.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,456.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,456.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.25
|
| Rate for Payer: Multiplan Commercial |
$2,184.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,062.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$973.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,476.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,476.05
|
|
|
HC WIRE INDIGO SEPERATOR
|
Facility
IP
|
$2,913.00
|
|
|
Service Code
|
CPT C1759
|
| Hospital Charge Code |
909000017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,398.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,339.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,573.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.10
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,456.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,456.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,456.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.25
|
| Rate for Payer: Multiplan Commercial |
$2,184.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,062.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$973.23
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
IP
|
$5,860.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,060.66 |
| Max. Negotiated Rate |
$4,395.00 |
| Rate for Payer: Adventist Health Commercial |
$1,172.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,025.82
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,967.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,967.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,060.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,465.00
|
| Rate for Payer: Multiplan Commercial |
$4,395.00
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
OP
|
$5,860.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,172.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$509.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,025.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cash Price |
$2,637.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,809.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,967.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,967.22
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,824.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,060.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,465.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$4,395.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,127.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,957.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC WOUND EXPLORATION TRAUMA EXTRE
|
Facility
OP
|
$2,681.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
900501282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$536.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,841.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,206.45
|
| Rate for Payer: Cash Price |
$1,206.45
|
| Rate for Payer: Cash Price |
$1,206.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,742.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: Dignity Health Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,025.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,815.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,815.04
|
| Rate for Payer: Humana Medicare |
$2,025.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,292.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,390.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$670.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,552.37
|
| Rate for Payer: Multiplan Commercial |
$2,010.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$973.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$895.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC WOUND EXPLORATION TRAUMA EXTRE
|
Facility
IP
|
$2,681.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
900501282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.26 |
| Max. Negotiated Rate |
$2,010.75 |
| Rate for Payer: Adventist Health Commercial |
$536.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,841.85
|
| Rate for Payer: Cash Price |
$1,206.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,815.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,815.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$670.25
|
| Rate for Payer: Multiplan Commercial |
$2,010.75
|
|
|
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 |
$123.85 |
| Max. Negotiated Rate |
$581.61 |
| Rate for Payer: Adventist Health Commercial |
$136.85
|
| Rate for Payer: Aetna of CA Gatekeeper |
$363.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$470.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$581.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$376.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$513.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.89
|
| Rate for Payer: Blue Shield of California Commercial |
$424.92
|
| Rate for Payer: Blue Shield of California EPN |
$401.65
|
| Rate for Payer: Cash Price |
$307.91
|
| Rate for Payer: Cash Price |
$307.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$314.76
|
| 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: Kaiser Permanente of CA Commercial |
$329.81
|
| 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 |
$249.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$228.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.61
|
| Rate for Payer: Vantage Medical Group Senior |
$581.61
|
|
|
HC WOUND MATRIX NEOX 100 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: Aetna of CA Non-Gatekeeper |
$470.08
|
| Rate for Payer: Cash Price |
$307.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$314.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.24
|
| Rate for Payer: Heritage Provider Network Senior |
$463.24
|
| 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 |
$249.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$228.61
|
|
|
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 |
$92.05 |
| Max. Negotiated Rate |
$432.28 |
| Rate for Payer: Adventist Health Commercial |
$101.71
|
| Rate for Payer: Aetna of CA Gatekeeper |
$363.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.38
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$432.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$279.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$381.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.89
|
| Rate for Payer: Blue Shield of California Commercial |
$315.82
|
| Rate for Payer: Blue Shield of California EPN |
$298.52
|
| Rate for Payer: Cash Price |
$228.85
|
| Rate for Payer: Cash Price |
$228.85
|
| 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: Kaiser Permanente of CA Commercial |
$245.13
|
| 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 |
$185.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$169.91
|
| 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: Aetna of CA Non-Gatekeeper |
$349.38
|
| Rate for Payer: Cash Price |
$228.85
|
| 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 |
$344.30
|
| Rate for Payer: Heritage Provider Network Senior |
$344.30
|
| 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 |
$185.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$169.91
|
|
|
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: Aetna of CA Non-Gatekeeper |
$221.62
|
| Rate for Payer: Cash Price |
$145.17
|
| 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 |
$218.39
|
| Rate for Payer: Heritage Provider Network Senior |
$218.39
|
| 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 |
$117.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$107.78
|
|
|
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 |
$363.39 |
| Rate for Payer: Adventist Health Commercial |
$64.52
|
| Rate for Payer: Aetna of CA Gatekeeper |
$363.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$221.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$274.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$177.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$241.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.89
|
| Rate for Payer: Blue Shield of California Commercial |
$200.33
|
| Rate for Payer: Blue Shield of California EPN |
$189.36
|
| Rate for Payer: Cash Price |
$145.17
|
| Rate for Payer: Cash Price |
$145.17
|
| 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: Kaiser Permanente of CA Commercial |
$155.49
|
| 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 |
$117.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$107.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$274.20
|
| Rate for Payer: Vantage Medical Group Senior |
$274.20
|
|
