|
HC APLS IGA
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900913647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$153.41 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.41
|
| Rate for Payer: Blue Shield of California Commercial |
$129.25
|
| Rate for Payer: Blue Shield of California Commercial |
$129.25
|
| Rate for Payer: Blue Shield of California EPN |
$103.67
|
| Rate for Payer: Blue Shield of California EPN |
$103.67
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.66
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$47.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC APLS IGA
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900913647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.59
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
|
|
HC APLS IGG
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900913648
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.76
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.02
|
| Rate for Payer: Heritage Provider Network Senior |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
|
|
HC APLS IGG
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900913648
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$147.97 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.11
|
| Rate for Payer: Blue Shield of California Commercial |
$147.97
|
| Rate for Payer: Blue Shield of California Commercial |
$147.97
|
| Rate for Payer: Blue Shield of California EPN |
$118.69
|
| Rate for Payer: Blue Shield of California EPN |
$118.69
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.28
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$61.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$47.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.45
|
| Rate for Payer: TriValley Medical Group Senior |
$25.45
|
| Rate for Payer: TriValley Medical Group Senior |
$25.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.49
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC APLS IGM
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900913649
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$153.41 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.41
|
| Rate for Payer: Blue Shield of California Commercial |
$129.25
|
| Rate for Payer: Blue Shield of California Commercial |
$129.25
|
| Rate for Payer: Blue Shield of California EPN |
$103.67
|
| Rate for Payer: Blue Shield of California EPN |
$103.67
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.68
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.07
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$47.66
|
| Rate for Payer: Heritage Provider Network Senior |
$32.19
|
| Rate for Payer: Heritage Provider Network Senior |
$47.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$36.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: TriValley Medical Group Senior |
$16.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC APLS IGM
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
900913649
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49.59
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.13
|
| Rate for Payer: Heritage Provider Network Senior |
$52.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.25
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
|
|
HC APP HIP SPICA CASE-ONE LEG
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 29305
|
| Hospital Charge Code |
900501680
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$411.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$316.35
|
| Rate for Payer: Blue Shield of California EPN |
$251.75
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$359.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$317.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$413.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$399.60
|
| Rate for Payer: TriValley Medical Group Senior |
$399.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC APP HIP SPICA CASE-ONE LEG
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 29305
|
| Hospital Charge Code |
900501680
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.90
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
|
|
HC APPLICATION HAND WRIST CAST
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901301202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$259.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.81
|
| 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 |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| 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 |
$392.45
|
| Rate for Payer: Heritage Provider Network Senior |
$392.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$302.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| 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 APPLICATION HAND WRIST CAST
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901301202
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC APPLICATION OF HAND/WRIST CAST
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.81
|
| 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 |
$301.15
|
| Rate for Payer: Blue Shield of California EPN |
$239.65
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| 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 |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$302.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Senior |
$380.40
|
| 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 APPLICATION OF HAND/WRIST CAST
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
900501373
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC APPLICATION OF HAND/WRIST CAST MCAL
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901300001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$408.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC APPLICATION OF HAND/WRIST CAST MCAL
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 29085
|
| Hospital Charge Code |
901300001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$259.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$391.81
|
| 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 |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| 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 |
$392.45
|
| Rate for Payer: Heritage Provider Network Senior |
$392.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$302.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| 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 APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$513.75 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$441.14
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
|
|
HC APPLICATION OF LONG ARM CAST
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
900501251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$137.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$325.38
|
| Rate for Payer: Blue Shield of California EPN |
$258.93
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cash Price |
$308.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$445.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$359.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.75
|
| Rate for Payer: Heritage Provider Network Senior |
$463.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$326.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$413.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$513.75
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$411.00
|
| Rate for Payer: TriValley Medical Group Senior |
$411.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC APP LONG LEG CAST
|
Facility
|
IP
|
$604.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$388.98
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
|
|
HC APP LONG LEG CAST
|
Facility
|
OP
|
$604.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
900501281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$286.90
|
| Rate for Payer: Blue Shield of California EPN |
$228.31
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cash Price |
$271.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$392.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$359.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$288.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$413.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$362.40
|
| Rate for Payer: TriValley Medical Group Senior |
$362.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC APP LONG LEG SPLINT
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
900501106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.35 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$510.05
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$536.18
|
| Rate for Payer: Heritage Provider Network Senior |
$536.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
|
|
HC APP LONG LEG SPLINT
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
900501106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$489.46
|
| 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 |
$376.20
|
| Rate for Payer: Blue Shield of California EPN |
$299.38
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$514.80
|
| 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 |
$536.18
|
| Rate for Payer: Heritage Provider Network Senior |
$536.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$377.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Senior |
$475.20
|
| 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 APPL TISS GLUE REPAIR EYE WND
|
Facility
|
OP
|
$2,674.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
900501481
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$483.99 |
| Max. Negotiated Rate |
$4,617.28 |
| Rate for Payer: Adventist Health Commercial |
$534.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,652.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,270.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,010.77
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,738.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,738.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,968.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,810.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,810.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,275.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$483.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,413.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$2,005.50
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,604.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,604.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC APPL TISS GLUE REPAIR EYE WND
|
Facility
|
IP
|
$2,674.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
900501481
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$483.99 |
| Max. Negotiated Rate |
$2,005.50 |
| Rate for Payer: Adventist Health Commercial |
$534.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,722.06
|
| Rate for Payer: Cash Price |
$1,203.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,810.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,810.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$483.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.50
|
| Rate for Payer: Multiplan Commercial |
$2,005.50
|
|
|
HC APP OF FIGURE EIGHT
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.75 |
| Max. Negotiated Rate |
$728.25 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$625.32
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.37
|
| Rate for Payer: Heritage Provider Network Senior |
$657.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.75
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
|
|
HC APP OF FIGURE EIGHT
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 29049
|
| Hospital Charge Code |
900501411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$600.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$461.23
|
| Rate for Payer: Blue Shield of California EPN |
$367.04
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$631.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$359.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.37
|
| Rate for Payer: Heritage Provider Network Senior |
$657.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$463.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$413.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$582.60
|
| Rate for Payer: TriValley Medical Group Senior |
$582.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC APP OF FINGER SPLINT-DYNAMIC
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
903208876
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Adventist Health Commercial |
$63.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$203.50
|
| Rate for Payer: Cash Price |
$142.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.93
|
| Rate for Payer: Heritage Provider Network Senior |
$213.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.00
|
| Rate for Payer: Multiplan Commercial |
$237.00
|
|
