|
HC OCC THER APP OF SURFACE NEUROSTIMULATOR
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 64550
|
| Hospital Charge Code |
901307015
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.87 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.88
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.79
|
| Rate for Payer: Heritage Provider Network Senior |
$182.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
|
|
HC OCC THER EVALUATION INITIAL 15MIN
|
Facility
|
IP
|
$214.00
|
|
| Hospital Charge Code |
901309051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$160.50 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.82
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$144.88
|
| Rate for Payer: Heritage Provider Network Senior |
$144.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.50
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
|
|
HC OCC THER EVALUATION INITIAL 15MIN
|
Facility
|
OP
|
$214.00
|
|
| Hospital Charge Code |
901309051
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$87.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$132.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.50
|
| 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 |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$139.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$181.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.47
|
| Rate for Payer: Heritage Provider Network Senior |
$132.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$102.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| 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 |
$181.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.90
|
| Rate for Payer: Vantage Medical Group Senior |
$181.90
|
|
|
HC OCC THER EVALUATION INITIAL 30MIN
|
Facility
|
IP
|
$757.00
|
|
| Hospital Charge Code |
901309050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$137.02 |
| Max. Negotiated Rate |
$567.75 |
| Rate for Payer: Adventist Health Commercial |
$151.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$487.51
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$512.49
|
| Rate for Payer: Heritage Provider Network Senior |
$512.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.25
|
| Rate for Payer: Multiplan Commercial |
$567.75
|
|
|
HC OCC THER EVALUATION INITIAL 30MIN
|
Facility
|
OP
|
$757.00
|
|
| Hospital Charge Code |
901309050
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$643.45 |
| Rate for Payer: Adventist Health Commercial |
$310.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$467.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$643.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$416.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$567.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$492.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$643.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$643.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$643.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$468.58
|
| Rate for Payer: Heritage Provider Network Senior |
$468.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$361.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.90
|
| Rate for Payer: Multiplan Commercial |
$567.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$643.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$643.45
|
| Rate for Payer: Vantage Medical Group Senior |
$643.45
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$128.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC OCCULT BLOOD, FECES 1-3 SIMUL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
900501612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$123.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.84
|
| Rate for Payer: Blue Shield of California Commercial |
$26.15
|
| Rate for Payer: Blue Shield of California EPN |
$20.97
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.87
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.38
|
| Rate for Payer: TriValley Medical Group Senior |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4.38
|
|
|
HC OCCULT BLOOD GASTRIC
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$30.17 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.17
|
| Rate for Payer: Blue Shield of California Commercial |
$26.15
|
| Rate for Payer: Blue Shield of California Commercial |
$26.15
|
| Rate for Payer: Blue Shield of California EPN |
$20.97
|
| Rate for Payer: Blue Shield of California EPN |
$20.97
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.95
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.32
|
| Rate for Payer: TriValley Medical Group Senior |
$5.32
|
| Rate for Payer: TriValley Medical Group Senior |
$5.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC OCCULT BLOOD GASTRIC
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900912329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.94
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC OCCULT BLOOD OTHR SOURCE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900911536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.18
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$83.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.17
|
| Rate for Payer: Blue Shield of California Commercial |
$26.15
|
| Rate for Payer: Blue Shield of California Commercial |
$26.15
|
| Rate for Payer: Blue Shield of California EPN |
$20.97
|
| Rate for Payer: Blue Shield of California EPN |
$20.97
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$87.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.32
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$83.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$64.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.32
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.32
|
| Rate for Payer: TriValley Medical Group Senior |
$5.32
|
| Rate for Payer: TriValley Medical Group Senior |
$5.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC OCCULT BLOOD OTHR SOURCE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900911536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$86.94
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$91.39
|
| Rate for Payer: Heritage Provider Network Senior |
$91.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
|
|
HC OMNIGRAFT 2.5X2.5 DERMAL REG MATRIX
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT Q4105
|
| Hospital Charge Code |
900104050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$357.75 |
| Rate for Payer: Adventist Health Commercial |
$95.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$294.79
|
| 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 |
$30.32
|
| Rate for Payer: Blue Shield of California Commercial |
$290.97
|
| Rate for Payer: Blue Shield of California EPN |
$232.78
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$219.42
|
| 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 |
$305.28
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.85
|
| Rate for Payer: Heritage Provider Network Senior |
$220.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$227.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$357.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$190.80
|
| Rate for Payer: TriValley Medical Group Senior |
$190.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$172.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.93
|
| 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 OMNIGRAFT 2.5X2.5 DERMAL REG MATRIX
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT Q4105
|
| Hospital Charge Code |
900104050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.34 |
| Max. Negotiated Rate |
$357.75 |
| Rate for Payer: Adventist Health Commercial |
$95.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$307.19
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$219.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$220.85
|
| Rate for Payer: Heritage Provider Network Senior |
$220.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.25
|
| Rate for Payer: Multiplan Commercial |
$357.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$172.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.93
|
|
|
HC OMNIGRAFT 4X4 DERMAL REG MATRIX
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT Q4105
|
| Hospital Charge Code |
900104051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$240.09 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.12
|
| 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 |
$30.32
|
| Rate for Payer: Blue Shield of California Commercial |
$153.11
|
| Rate for Payer: Blue Shield of California EPN |
$122.49
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.46
|
| 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 |
$160.64
|
| Rate for Payer: EPIC Health Plan Medicare |
$160.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.21
|
| Rate for Payer: Heritage Provider Network Senior |
$116.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$160.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$119.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.40
|
| Rate for Payer: TriValley Medical Group Senior |
$100.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.11
|
| 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 OMNIGRAFT 4X4 DERMAL REG MATRIX
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT Q4105
|
| Hospital Charge Code |
900104051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$188.25 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$161.64
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$115.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.21
|
| Rate for Payer: Heritage Provider Network Senior |
$116.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.75
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.11
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
|
OP
|
$16,864.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,052.38 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$3,372.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,421.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,010.40
|
| Rate for Payer: Blue Shield of California EPN |
$6,374.59
|
| Rate for Payer: Cash Price |
$7,588.80
|
| Rate for Payer: Cash Price |
$7,588.80
|
| Rate for Payer: Cash Price |
$7,588.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,961.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,416.93
|
| Rate for Payer: Heritage Provider Network Senior |
$11,416.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,044.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,052.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,216.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$12,648.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$10,118.40
|
| Rate for Payer: TriValley Medical Group Senior |
$10,118.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
|
IP
|
$16,864.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,052.38 |
| Max. Negotiated Rate |
$12,648.00 |
| Rate for Payer: Adventist Health Commercial |
$3,372.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,860.42
|
| Rate for Payer: Cash Price |
$7,588.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,416.93
|
| Rate for Payer: Heritage Provider Network Senior |
$11,416.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,052.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,216.00
|
| Rate for Payer: Multiplan Commercial |
$12,648.00
|
|
|
HC OPEN TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$34,467.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
900524615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,238.53 |
| Max. Negotiated Rate |
$25,850.25 |
| Rate for Payer: Adventist Health Commercial |
$6,893.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,300.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16,371.83
|
| Rate for Payer: Blue Shield of California EPN |
$13,028.53
|
| Rate for Payer: Cash Price |
$15,510.15
|
| Rate for Payer: Cash Price |
$15,510.15
|
| Rate for Payer: Cash Price |
$15,510.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$22,403.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,334.16
|
| Rate for Payer: Heritage Provider Network Senior |
$23,334.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$16,440.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,238.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,616.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$25,850.25
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$20,680.20
|
| Rate for Payer: TriValley Medical Group Senior |
$20,680.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC OPEN TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$34,467.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
900524615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,238.53 |
| Max. Negotiated Rate |
$25,850.25 |
| Rate for Payer: Adventist Health Commercial |
$6,893.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,196.75
|
| Rate for Payer: Cash Price |
$15,510.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,334.16
|
| Rate for Payer: Heritage Provider Network Senior |
$23,334.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,238.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,616.75
|
| Rate for Payer: Multiplan Commercial |
$25,850.25
|
|
|
HC OPEN TREAT FINGER FX, EA
|
Facility
|
OP
|
$6,090.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
900501422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,763.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,892.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,302.02
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,958.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,904.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,102.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,654.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,654.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC OPEN TREAT FINGER FX, EA
|
Facility
|
IP
|
$6,090.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
900501422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,921.96
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,102.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
IP
|
$6,090.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,921.96
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,102.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
OP
|
$6,090.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,763.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,892.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,302.02
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,958.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,904.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,102.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,654.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,654.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC OPEN TREAT/FINGER/TOE FRACTURE
|
Facility
|
OP
|
$6,090.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
900501351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,763.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,892.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,302.02
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,958.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,904.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,102.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,654.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,654.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC OPEN TREAT/FINGER/TOE FRACTURE
|
Facility
|
IP
|
$6,090.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
900501351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,921.96
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,102.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
|
