|
HC WEEKLY PHYSICS
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$238.20 |
| Max. Negotiated Rate |
$987.00 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$847.50
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.93
|
| Rate for Payer: Heritage Provider Network Senior |
$890.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$238.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.00
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
|
|
HC WEEKLY PHYSICS
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$146.94 |
| Max. Negotiated Rate |
$987.00 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$813.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$714.20
|
| Rate for Payer: Blue Shield of California Commercial |
$627.07
|
| Rate for Payer: Blue Shield of California EPN |
$504.27
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$855.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$855.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$172.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$814.60
|
| Rate for Payer: Heritage Provider Network Senior |
$814.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$627.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$238.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.65
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$146.94
|
| Rate for Payer: TriValley Medical Group Senior |
$146.94
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$658.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$658.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Vantage Medical Group Senior |
$172.87
|
|
|
HC WET MOUNT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.22
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
|
|
HC WET MOUNT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$126.22
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
|
|
HC WET MOUNT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.53
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.32
|
| Rate for Payer: Heritage Provider Network Senior |
$121.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC WET MOUNT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$121.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$93.10
|
| Rate for Payer: Blue Shield of California EPN |
$74.09
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$93.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Senior |
$117.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.18
|
| Rate for Payer: Heritage Provider Network Senior |
$97.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.11
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.29
|
| Rate for Payer: Heritage Provider Network Senior |
$106.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$38.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$58.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Senior |
$58.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$45.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$66.50
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$80.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.75
|
| Rate for Payer: Vantage Medical Group Senior |
$80.75
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.18
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.31
|
| Rate for Payer: Heritage Provider Network Senior |
$64.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
|
|
HC WHEELCHAIR MGMT 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900417542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.18
|
| Rate for Payer: Heritage Provider Network Senior |
$97.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$74.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHEELCHAIR MGMT 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900417542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$101.11
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.29
|
| Rate for Payer: Heritage Provider Network Senior |
$106.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
|
|
HC WHFO FINGER EXT W/CLOCK SPRIN
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$57.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$87.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$56.68
|
| Rate for Payer: Blue Shield of California EPN |
$56.68
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.28
|
| Rate for Payer: Heritage Provider Network Senior |
$65.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$70.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.70
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.85
|
| Rate for Payer: Vantage Medical Group Senior |
$119.85
|
|
|
HC WHFO FINGER EXT W/CLOCK SPRIN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$56.68
|
| Rate for Payer: Blue Shield of California EPN |
$56.68
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.28
|
| Rate for Payer: Heritage Provider Network Senior |
$65.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$70.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.69
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$346.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$225.12
|
| Rate for Payer: Blue Shield of California EPN |
$225.12
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$257.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$259.28
|
| Rate for Payer: Heritage Provider Network Senior |
$259.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$202.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$185.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$360.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$225.12
|
| Rate for Payer: Blue Shield of California EPN |
$225.12
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$259.28
|
| Rate for Payer: Heritage Provider Network Senior |
$259.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$202.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$185.42
|
|
|
HC WHFO LONG OPPONENS WO ATTACH
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309111
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$187.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$602.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$376.27
|
| Rate for Payer: Blue Shield of California EPN |
$376.27
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$430.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.37
|
| Rate for Payer: Heritage Provider Network Senior |
$433.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$702.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$338.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$309.91
|
|
|
HC WHFO LONG OPPONENS WO ATTACH
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309111
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$383.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$578.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$514.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$376.27
|
| Rate for Payer: Blue Shield of California EPN |
$376.27
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$430.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$795.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$795.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$795.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$599.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.37
|
| Rate for Payer: Heritage Provider Network Senior |
$433.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$468.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$655.20
|
| Rate for Payer: Multiplan Commercial |
$702.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$338.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$309.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$795.60
|
| Rate for Payer: Vantage Medical Group Senior |
$795.60
|
|
|
HC WHFO OPPENHEIMER OT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$346.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$225.12
|
| Rate for Payer: Blue Shield of California EPN |
$225.12
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$257.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$259.28
|
| Rate for Payer: Heritage Provider Network Senior |
$259.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$202.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$185.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC WHFO OPPENHEIMER OT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$360.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$225.12
|
| Rate for Payer: Blue Shield of California EPN |
$225.12
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$259.28
|
| Rate for Payer: Heritage Provider Network Senior |
$259.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$202.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$185.42
|
|
|
HC WHFO WRIST GAUNTLET MOLDED
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
901309100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$311.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$469.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$646.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$418.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$570.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$305.52
|
| Rate for Payer: Blue Shield of California EPN |
$305.52
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$646.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$646.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$646.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.88
|
| Rate for Payer: Heritage Provider Network Senior |
$351.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$380.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$380.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$532.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$274.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$646.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$646.00
|
| Rate for Payer: Vantage Medical Group Senior |
$646.00
|
|
|
HC WHFO WRIST GAUNTLET MOLDED
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
901309100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$489.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$305.52
|
| Rate for Payer: Blue Shield of California EPN |
$305.52
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.88
|
| Rate for Payer: Heritage Provider Network Senior |
$351.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$380.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$380.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$380.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$274.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.64
|
|
|
HC WHFO WRIST GAUNT W/THUMB SPIC
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Adventist Health Commercial |
$383.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$578.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$514.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$608.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$795.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$795.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$795.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$608.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$579.38
|
| Rate for Payer: Heritage Provider Network Senior |
$579.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$446.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$655.20
|
| Rate for Payer: Multiplan Commercial |
$702.00
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$795.60
|
| Rate for Payer: Vantage Medical Group Senior |
$795.60
|
|
|
HC WHFO WRIST GAUNT W/THUMB SPIC
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$169.42 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$187.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$602.78
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.67
|
| Rate for Payer: Heritage Provider Network Senior |
$633.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$702.00
|
|
|
HC WHIRLPOOL MCAL
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.22
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.63
|
| Rate for Payer: Heritage Provider Network Senior |
$172.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
|
