|
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 |
$363.39 |
| Rate for Payer: Adventist Health Commercial |
$43.72
|
| Rate for Payer: Aetna of CA Gatekeeper |
$363.39
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$150.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$185.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$120.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$163.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.89
|
| Rate for Payer: Blue Shield of California Commercial |
$135.75
|
| Rate for Payer: Blue Shield of California EPN |
$128.32
|
| Rate for Payer: Cash Price |
$98.37
|
| Rate for Payer: Cash Price |
$98.37
|
| 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: Kaiser Permanente of CA Commercial |
$105.37
|
| 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 |
$79.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.81
|
| Rate for Payer: Vantage Medical Group Senior |
$185.81
|
|
|
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: Aetna of CA Non-Gatekeeper |
$150.18
|
| Rate for Payer: Cash Price |
$98.37
|
| 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 |
$147.99
|
| Rate for Payer: Heritage Provider Network Senior |
$147.99
|
| 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 |
$79.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.03
|
|
|
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 |
$77.52 |
| Rate for Payer: Adventist Health Commercial |
$8.51
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$29.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.91
|
| Rate for Payer: Blue Shield of California Commercial |
$26.42
|
| Rate for Payer: Blue Shield of California EPN |
$24.98
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Cash Price |
$19.15
|
| 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: Kaiser Permanente of CA Commercial |
$20.51
|
| 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 |
$15.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.22
|
| 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: Aetna of CA Non-Gatekeeper |
$29.23
|
| Rate for Payer: Cash Price |
$19.15
|
| 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 |
$28.81
|
| Rate for Payer: Heritage Provider Network Senior |
$28.81
|
| 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 |
$15.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.22
|
|
|
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 |
$77.52 |
| Rate for Payer: Adventist Health Commercial |
$8.36
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$31.36
|
| Rate for Payer: Blue Shield of California Commercial |
$25.96
|
| Rate for Payer: Blue Shield of California EPN |
$24.54
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Cash Price |
$18.81
|
| 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: Kaiser Permanente of CA Commercial |
$20.15
|
| 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 |
$15.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.97
|
| 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: Aetna of CA Non-Gatekeeper |
$28.72
|
| Rate for Payer: Cash Price |
$18.81
|
| 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 |
$28.31
|
| Rate for Payer: Heritage Provider Network Senior |
$28.31
|
| 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 |
$15.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13.97
|
|
|
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: Aetna of CA Non-Gatekeeper |
$58.26
|
| Rate for Payer: Cash Price |
$38.16
|
| 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 |
$57.41
|
| Rate for Payer: Heritage Provider Network Senior |
$57.41
|
| 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 |
$30.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.33
|
|
|
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 |
$77.52 |
| Rate for Payer: Adventist Health Commercial |
$16.96
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$72.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$46.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$63.60
|
| Rate for Payer: Blue Shield of California Commercial |
$52.66
|
| Rate for Payer: Blue Shield of California EPN |
$49.78
|
| Rate for Payer: Cash Price |
$38.16
|
| Rate for Payer: Cash Price |
$38.16
|
| 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: Kaiser Permanente of CA Commercial |
$40.87
|
| 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 |
$30.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$28.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.08
|
| Rate for Payer: Vantage Medical Group Senior |
$72.08
|
|
|
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: Aetna of CA Non-Gatekeeper |
$37.92
|
| Rate for Payer: Cash Price |
$24.84
|
| 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 |
$37.37
|
| Rate for Payer: Heritage Provider Network Senior |
$37.37
|
| 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 |
$20.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.44
|
|
|
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 |
$77.52 |
| Rate for Payer: Adventist Health Commercial |
$11.04
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.40
|
| Rate for Payer: Blue Shield of California Commercial |
$34.28
|
| Rate for Payer: Blue Shield of California EPN |
$32.40
|
| Rate for Payer: Cash Price |
$24.84
|
| Rate for Payer: Cash Price |
$24.84
|
| 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: Kaiser Permanente of CA Commercial |
$26.61
|
| 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 |
$20.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.44
|
| 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
|
$849.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
909000115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$169.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$721.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$466.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$636.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$382.05
|
| Rate for Payer: Cash Price |
$382.05
|
| Rate for Payer: Cash Price |
$382.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$551.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$721.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$721.65
|
| Rate for Payer: Dignity Health Senior |
$721.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$525.53
|
| Rate for Payer: Heritage Provider Network Senior |
$525.53
|
| Rate for Payer: IEHP Medi-Cal |
$284.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$409.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.25
|
| Rate for Payer: Multiplan Commercial |
$636.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$721.65
|
| Rate for Payer: Vantage Medical Group Senior |
$721.65
|
|
|
HC WRIST ARTHROGRAPHY INJECT
|
Facility
IP
|
$849.00
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
909000115
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.67 |
| Max. Negotiated Rate |
$636.75 |
| Rate for Payer: Adventist Health Commercial |
$169.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$583.26
|
| Rate for Payer: Cash Price |
$382.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$574.77
|
| Rate for Payer: Heritage Provider Network Senior |
$574.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.25
|
| Rate for Payer: Multiplan Commercial |
$636.75
|
|
|
HC WRIST COMPLETE MIN 3 VIEWS
|
Facility
IP
|
$599.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
909001210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$411.51
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.52
|
| Rate for Payer: Heritage Provider Network Senior |
$405.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.75
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
|
|
HC WRIST COMPLETE MIN 3 VIEWS
|
Facility
OP
|
$599.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
909001210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.22 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$61.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$411.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.02
|
| Rate for Payer: Blue Shield of California Commercial |
$106.76
|
| Rate for Payer: Blue Shield of California EPN |
$60.71
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$389.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.78
|
| Rate for Payer: Heritage Provider Network Senior |
$370.78
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$39.22
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC WRIST LIMITED
|
Facility
OP
|
$509.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
909001514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.11
|
| Rate for Payer: Blue Shield of California Commercial |
$98.89
|
| Rate for Payer: Blue Shield of California EPN |
$56.23
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$330.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$315.07
|
| Rate for Payer: Heritage Provider Network Senior |
$315.07
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$26.99
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC WRIST LIMITED
|
Facility
IP
|
$509.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
909001514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.13 |
| Max. Negotiated Rate |
$381.75 |
| Rate for Payer: Adventist Health Commercial |
$101.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$349.68
|
| Rate for Payer: Cash Price |
$229.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.59
|
| Rate for Payer: Heritage Provider Network Senior |
$344.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.25
|
| Rate for Payer: Multiplan Commercial |
$381.75
|
|
|
HC XA INHIBITION LMW HEPARIN
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900910107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$88.62
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$87.33
|
| Rate for Payer: Heritage Provider Network Senior |
$87.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.25
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
|
|
HC XA INHIBITION LMW HEPARIN
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
900910107
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$102.24 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.11
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$50.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.09
|
| Rate for Payer: Blue Shield of California Commercial |
$102.24
|
| Rate for Payer: Blue Shield of California EPN |
$79.93
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$47.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.40
|
| Rate for Payer: Dignity Health Senior |
$13.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$13.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.19
|
| Rate for Payer: Heritage Provider Network Senior |
$45.19
|
| Rate for Payer: Humana Medicare |
$13.09
|
| Rate for Payer: IEHP Medi-Cal |
$17.89
|
| Rate for Payer: IEHP Medicare Advantage |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$24.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.49
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$13.09
|
| Rate for Payer: TriValley Medical Group Senior |
$13.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Vantage Medical Group Senior |
$13.09
|
|
|
HC XE 133, PER 10 MCI
|
Facility
IP
|
$473.00
|
|
|
Service Code
|
CPT A9558
|
| Hospital Charge Code |
909301526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$324.95
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.22
|
| Rate for Payer: Heritage Provider Network Senior |
$320.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$172.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$158.03
|
|
|
HC XE 133, PER 10 MCI
|
Facility
OP
|
$473.00
|
|
|
Service Code
|
CPT A9558
|
| Hospital Charge Code |
909301526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$402.05 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$402.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$260.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$354.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.55
|
| Rate for Payer: Blue Shield of California Commercial |
$293.73
|
| Rate for Payer: Blue Shield of California EPN |
$277.65
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$217.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.05
|
| Rate for Payer: Dignity Health Senior |
$402.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$219.00
|
| Rate for Payer: Heritage Provider Network Senior |
$219.00
|
| Rate for Payer: IEHP Medi-Cal |
$367.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.25
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$172.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$158.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.05
|
| Rate for Payer: Vantage Medical Group Senior |
$402.05
|
|
|
HC XENON PERFUSION SCAN
|
Facility
IP
|
$1,810.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$327.61 |
| Max. Negotiated Rate |
$1,357.50 |
| Rate for Payer: Adventist Health Commercial |
$362.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,243.47
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,225.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,225.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.50
|
| Rate for Payer: Multiplan Commercial |
$1,357.50
|
|
|
HC XENON PERFUSION SCAN
|
Facility
OP
|
$1,810.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
909301401
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$246.39 |
| Max. Negotiated Rate |
$1,357.50 |
| Rate for Payer: Adventist Health Commercial |
$362.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$339.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,243.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,048.24
|
| Rate for Payer: Blue Shield of California Commercial |
$871.51
|
| Rate for Payer: Blue Shield of California EPN |
$495.60
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cash Price |
$814.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,176.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,120.39
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.39
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: IEHP Medi-Cal |
$246.39
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,357.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC XPEEDIOR ANGIOJET, CATH
|
Facility
OP
|
$2,556.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,226.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,755.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,172.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,405.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,917.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,587.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,500.37
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,175.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,172.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,172.60
|
| Rate for Payer: Dignity Health Senior |
$2,172.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,635.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,183.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,183.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,278.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,278.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,278.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.00
|
| Rate for Payer: Multiplan Commercial |
$1,917.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$931.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$853.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,172.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,172.60
|
|
|
HC XPEEDIOR ANGIOJET, CATH
|
Facility
IP
|
$2,556.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$511.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,226.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,755.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cash Price |
$1,150.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,175.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,380.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,730.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,730.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,278.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,278.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,278.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$639.00
|
| Rate for Payer: Multiplan Commercial |
$1,917.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$931.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$853.96
|
|
|
HC XRAY ENTIRE SPI 1 VIEW
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
909072081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.63
|
| Rate for Payer: Blue Shield of California Commercial |
$138.68
|
| Rate for Payer: Blue Shield of California EPN |
$78.86
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$346.64
|
| Rate for Payer: Heritage Provider Network Senior |
$346.64
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: IEHP Medi-Cal |
$54.16
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$97.28
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$97.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
