|
HC WHIRLPOOL MCAL
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$104.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.25
|
| 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 |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$121.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| 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 |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC WHIRLPOOL MCARE COM
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
HC WHIRLPOOL MCARE COM
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$104.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.25
|
| 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 |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$121.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| 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 |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC WHIRLPOOL OT
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
903207022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$104.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.25
|
| 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 |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$121.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| 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 |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC WHIRLPOOL OT
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
903207022
|
|
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
|
|
|
HC WHIRLPOOL PT
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900419063
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
HC WHIRLPOOL PT
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
905103118
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$104.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.25
|
| 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 |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$121.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| 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 |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC WHIRLPOOL PT
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
905103118
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
HC WHIRLPOOL PT
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900419063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$104.55
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$157.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.25
|
| 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 |
$114.75
|
| Rate for Payer: Cash Price |
$114.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$121.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| 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 |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC WHITAKER TEST
|
Facility
|
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
909000169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.61 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,046.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,101.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$986.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$896.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$896.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,048.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,103.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,704.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$306.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,031.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,201.77
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$986.52
|
| Rate for Payer: TriValley Medical Group Senior |
$986.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Vantage Medical Group Senior |
$896.84
|
|
|
HC WHITAKER TEST
|
Facility
|
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
909000169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.61 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,090.94
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,146.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,146.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$306.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
|
|
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 |
$28.78
|
| 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 Foundation Hospitals 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 Non-Gatekeeper |
$27.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.35
|
| Rate for Payer: Blue Shield of California Commercial |
$27.26
|
| Rate for Payer: Blue Shield of California EPN |
$21.81
|
| 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 Medicare Advantage |
$37.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.66
|
| Rate for Payer: Heritage Provider Network Senior |
$27.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$21.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.28
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.99
|
| Rate for Payer: Vantage Medical Group Senior |
$37.99
|
|
|
HC WINDOWING OF CAST
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.89
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC WINDOWING OF CAST
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$366.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$281.68
|
| Rate for Payer: Blue Shield of California EPN |
$224.15
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$209.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$282.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$355.80
|
| Rate for Payer: TriValley Medical Group Senior |
$355.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,800.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,602.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,184.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,171.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,171.03
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,456.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,456.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,456.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,039.10
|
| Rate for Payer: Multiplan Commercial |
$2,184.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,052.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$964.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,476.05
|
| 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 |
$13,808.00 |
| Rate for Payer: Cigna of CA HMO/PPO |
$1,339.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,573.02
|
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,875.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,171.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,171.03
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Cash Price |
$1,310.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,348.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,348.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,456.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,456.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$1,052.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$964.49
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
|
IP
|
$6,402.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,158.76 |
| Max. Negotiated Rate |
$4,801.50 |
| Rate for Payer: Adventist Health Commercial |
$1,280.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,122.89
|
| Rate for Payer: Cash Price |
$2,880.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,334.15
|
| Rate for Payer: Heritage Provider Network Senior |
$4,334.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,158.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,600.50
|
| Rate for Payer: Multiplan Commercial |
$4,801.50
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
|
OP
|
$6,402.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,158.76 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,280.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,956.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,040.95
|
| Rate for Payer: Blue Shield of California EPN |
$2,419.96
|
| Rate for Payer: Cash Price |
$2,880.90
|
| Rate for Payer: Cash Price |
$2,880.90
|
| Rate for Payer: Cash Price |
$2,880.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,161.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,653.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,334.15
|
| Rate for Payer: Heritage Provider Network Senior |
$4,334.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,053.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,158.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,051.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,600.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$4,801.50
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,841.20
|
| Rate for Payer: TriValley Medical Group Senior |
$3,841.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC WOUND EXPLORATION TRAUMA EXTRE
|
Facility
|
OP
|
$2,929.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
900501282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$530.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$585.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,810.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,391.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,107.16
|
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,903.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,124.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,982.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,982.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,397.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$530.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,442.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,846.47
|
| Rate for Payer: Multiplan Commercial |
$2,196.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,757.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,757.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC WOUND EXPLORATION TRAUMA EXTRE
|
Facility
|
IP
|
$2,929.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
900501282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$530.15 |
| Max. Negotiated Rate |
$2,196.75 |
| Rate for Payer: Adventist Health Commercial |
$585.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,886.28
|
| Rate for Payer: Cash Price |
$1,318.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,982.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,982.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$530.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.25
|
| Rate for Payer: Multiplan Commercial |
$2,196.75
|
|
|
HC WOUND 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 |
$513.19 |
| Rate for Payer: Adventist Health Commercial |
$136.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$422.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.59
|
| Rate for Payer: Blue Shield of California Commercial |
$417.39
|
| Rate for Payer: Blue Shield of California EPN |
$333.91
|
| Rate for Payer: Cash Price |
$307.91
|
| Rate for Payer: Cash Price |
$307.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$314.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.92
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.81
|
| Rate for Payer: Heritage Provider Network Senior |
$316.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$326.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$513.19
|
| Rate for Payer: TriValley Medical Group Commercial |
$273.70
|
| Rate for Payer: TriValley Medical Group Senior |
$273.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$247.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
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 |
$440.66
|
| Rate for Payer: Cash Price |
$307.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$314.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$316.81
|
| Rate for Payer: Heritage Provider Network Senior |
$316.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.06
|
| Rate for Payer: Multiplan Commercial |
$513.19
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$247.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$226.56
|
|
|
HC WOUND MATRIX NEOX 100 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 |
$381.42 |
| Rate for Payer: Adventist Health Commercial |
$101.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$314.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.59
|
| Rate for Payer: Blue Shield of California Commercial |
$310.22
|
| Rate for Payer: Blue Shield of California EPN |
$248.18
|
| Rate for Payer: Cash Price |
$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 |
$240.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.48
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.46
|
| Rate for Payer: Heritage Provider Network Senior |
$235.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$242.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$381.42
|
| Rate for Payer: TriValley Medical Group Commercial |
$203.42
|
| Rate for Payer: TriValley Medical Group Senior |
$203.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$183.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$168.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.07
|
| Rate for Payer: Vantage Medical Group Senior |
$160.06
|
|
|
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 |
$327.51
|
| 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 |
$235.46
|
| Rate for Payer: Heritage Provider Network Senior |
$235.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.14
|
| Rate for Payer: Multiplan Commercial |
$381.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$183.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$168.38
|
|
