|
HC APP OF SHORT ARM SPLINT MCAL
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300005
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
|
|
HC APP OF SHORT ARM SPLINT MCARE COMM
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300088
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$88.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$248.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$88.34
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$853.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$807.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$769.42
|
| Rate for Payer: Heritage Provider Network Senior |
$769.42
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$932.25
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC APP OF SHORT ARM SPLINT MCARE COMM
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
901300088
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$224.98 |
| Max. Negotiated Rate |
$932.25 |
| Rate for Payer: Adventist Health Commercial |
$248.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$853.94
|
| Rate for Payer: Cash Price |
$559.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$841.51
|
| Rate for Payer: Heritage Provider Network Senior |
$841.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.75
|
| Rate for Payer: Multiplan Commercial |
$932.25
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
903208874
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$183.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.56
|
| Rate for Payer: Heritage Provider Network Senior |
$174.56
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
903208874
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$51.04 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$193.73
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$190.91
|
| Rate for Payer: Heritage Provider Network Senior |
$190.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC MCAL
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
901300007
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$142.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$107.63
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$487.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$461.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.49
|
| Rate for Payer: Heritage Provider Network Senior |
$439.49
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC APP SHORT ARM SPLINT-DYNAMIC MCAL
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT 29126
|
| Hospital Charge Code |
901300007
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$128.51 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Adventist Health Commercial |
$142.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$487.77
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.67
|
| Rate for Payer: Heritage Provider Network Senior |
$480.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.50
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
|
|
HC APP SHORT LEG CAST
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.09 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$379.91
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$374.38
|
| Rate for Payer: Heritage Provider Network Senior |
$374.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.25
|
| Rate for Payer: Multiplan Commercial |
$414.75
|
|
|
HC APP SHORT LEG CAST
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
900501104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$131.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$379.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$359.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: Dignity Health Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$335.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$374.38
|
| Rate for Payer: Heritage Provider Network Senior |
$374.38
|
| Rate for Payer: Humana Medicare |
$335.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$266.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$422.79
|
| Rate for Payer: Multiplan Commercial |
$414.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$184.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.09 |
| Max. Negotiated Rate |
$414.75 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$379.91
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$374.38
|
| Rate for Payer: Heritage Provider Network Senior |
$374.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.25
|
| Rate for Payer: Multiplan Commercial |
$414.75
|
|
|
HC APP SHORT LEG CAST WLK/AMB
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
900501105
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$110.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$141.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$379.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cash Price |
$248.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$359.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: Dignity Health Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$335.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$374.38
|
| Rate for Payer: Heritage Provider Network Senior |
$374.38
|
| Rate for Payer: Humana Medicare |
$335.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$266.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$422.79
|
| Rate for Payer: Multiplan Commercial |
$414.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$200.79
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$184.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.70
|
| Rate for Payer: Dignity Health Senior |
$86.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.14
|
| Rate for Payer: Heritage Provider Network Senior |
$63.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$49.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.70
|
| Rate for Payer: Vantage Medical Group Senior |
$86.70
|
|
|
HC AQUATIC THERAPY EA ADDL 15 MIN MCAL
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
900400041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.07
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.05
|
| Rate for Payer: Heritage Provider Network Senior |
$69.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
905103142
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$173.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.75
|
| Rate for Payer: Dignity Health Senior |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.75
|
| Rate for Payer: Vantage Medical Group Senior |
$267.75
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
905103142
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.40
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.26
|
| Rate for Payer: Heritage Provider Network Senior |
$213.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900417113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$209.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$198.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Dignity Health Senior |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.80
|
| Rate for Payer: Heritage Provider Network Senior |
$188.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$147.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.25
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900417113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$228.75 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$209.54
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$206.48
|
| Rate for Payer: Heritage Provider Network Senior |
$206.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.25
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
|
|
HC ARCH AORTA
|
Facility
|
OP
|
$9,643.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
906820219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$271.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,928.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,624.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$4,339.35
|
| Rate for Payer: Cash Price |
$4,339.35
|
| Rate for Payer: Cash Price |
$4,339.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,267.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,969.02
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$271.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,745.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,410.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$7,232.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ARCH AORTA
|
Facility
|
IP
|
$6,021.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,089.80 |
| Max. Negotiated Rate |
$4,515.75 |
| Rate for Payer: Adventist Health Commercial |
$1,204.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,136.43
|
| Rate for Payer: Cash Price |
$2,709.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,076.22
|
| Rate for Payer: Heritage Provider Network Senior |
$4,076.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,089.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.25
|
| Rate for Payer: Multiplan Commercial |
$4,515.75
|
|
|
HC ARCH AORTA
|
Facility
|
OP
|
$6,021.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$271.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,204.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,136.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,709.45
|
| Rate for Payer: Cash Price |
$2,709.45
|
| Rate for Payer: Cash Price |
$2,709.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,913.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,727.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$271.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,089.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$4,515.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ARCH AORTA
|
Facility
|
IP
|
$9,643.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
906820219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,745.38 |
| Max. Negotiated Rate |
$7,232.25 |
| Rate for Payer: Adventist Health Commercial |
$1,928.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,624.74
|
| Rate for Payer: Cash Price |
$4,339.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,528.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6,528.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,745.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,410.75
|
| Rate for Payer: Multiplan Commercial |
$7,232.25
|
|
|
HC ARGON, THROMBEC CATH
|
Facility
|
IP
|
$2,827.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$565.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,357.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,942.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,300.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,526.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,914.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,914.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,413.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.88
|
| Rate for Payer: Multiplan Commercial |
$2,120.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,030.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$944.67
|
|
|
HC ARGON, THROMBEC CATH
|
Facility
|
OP
|
$2,827.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$565.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,357.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,942.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,555.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,755.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,659.74
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,300.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.38
|
| Rate for Payer: Dignity Health Senior |
$2,403.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,809.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,309.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,309.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,413.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.88
|
| Rate for Payer: Multiplan Commercial |
$2,120.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,030.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$944.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.38
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,011.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.00
|
| 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 |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$956.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.20
|
| Rate for Payer: Dignity Health Senior |
$1,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$911.17
|
| Rate for Payer: Heritage Provider Network Senior |
$911.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$709.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.00
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| 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 |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,251.20
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.43 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,011.26
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$996.54
|
| Rate for Payer: Heritage Provider Network Senior |
$996.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.00
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
|
