|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$8,101.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
906820283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,466.28 |
| Max. Negotiated Rate |
$6,075.75 |
| Rate for Payer: Adventist Health Commercial |
$1,620.20
|
| Rate for Payer: Cash Price |
$4,455.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,484.38
|
| Rate for Payer: Heritage Provider Network Senior |
$5,484.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,466.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,025.25
|
| Rate for Payer: Multiplan Commercial |
$6,075.75
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$6,886.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,730.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,787.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,164.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,475.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,853.10
|
| Rate for Payer: Dignity Health Senior |
$5,853.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,262.43
|
| Rate for Payer: Heritage Provider Network Senior |
$4,262.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,021.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,284.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,246.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,721.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,820.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,820.20
|
| Rate for Payer: Multiplan Commercial |
$5,164.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,853.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,853.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5,853.10
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$8,101.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
906820283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,620.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,565.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,885.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,455.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,075.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,455.55
|
| Rate for Payer: Cash Price |
$4,455.55
|
| Rate for Payer: Cash Price |
$4,455.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,265.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,885.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,885.85
|
| Rate for Payer: Dignity Health Senior |
$6,885.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,014.52
|
| Rate for Payer: Heritage Provider Network Senior |
$5,014.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,021.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,864.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,466.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,025.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,670.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,670.70
|
| Rate for Payer: Multiplan Commercial |
$6,075.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,885.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,885.85
|
| Rate for Payer: Vantage Medical Group Senior |
$6,885.85
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$6,886.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,246.37 |
| Max. Negotiated Rate |
$5,164.50 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Cash Price |
$3,787.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,661.82
|
| Rate for Payer: Heritage Provider Network Senior |
$4,661.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,246.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,721.50
|
| Rate for Payer: Multiplan Commercial |
$5,164.50
|
|
|
HC STNT TRACHEO WALLGRFT W/UNI 20
|
Facility
|
IP
|
$9,420.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,884.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,884.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,521.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,786.84
|
| Rate for Payer: Blue Shield of California EPN |
$3,786.84
|
| Rate for Payer: Cash Price |
$5,181.00
|
| Rate for Payer: Cash Price |
$5,181.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,333.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,086.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,361.46
|
| Rate for Payer: Heritage Provider Network Senior |
$4,361.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,710.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,710.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,710.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,355.00
|
| Rate for Payer: Multiplan Commercial |
$7,065.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,403.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,118.96
|
|
|
HC STNT TRACHEO WALLGRFT W/UNI 20
|
Facility
|
OP
|
$9,420.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081433
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,884.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,884.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,521.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,471.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,181.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,065.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,786.84
|
| Rate for Payer: Blue Shield of California EPN |
$3,786.84
|
| Rate for Payer: Cash Price |
$5,181.00
|
| Rate for Payer: Cash Price |
$5,181.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,333.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,007.00
|
| Rate for Payer: Dignity Health Senior |
$8,007.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,028.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,361.46
|
| Rate for Payer: Heritage Provider Network Senior |
$4,361.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,710.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,710.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,710.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,355.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,594.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,594.00
|
| Rate for Payer: Multiplan Commercial |
$7,065.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,403.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,118.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,007.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,007.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,007.00
|
|
|
HC STNT WALL CAROTID
|
Facility
|
OP
|
$6,425.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,084.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,413.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,533.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,818.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,582.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,582.85
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,955.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,461.25
|
| Rate for Payer: Dignity Health Senior |
$5,461.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,112.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,974.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,974.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,212.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,212.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,212.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,606.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,497.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,497.50
|
| Rate for Payer: Multiplan Commercial |
$4,818.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,321.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,127.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,461.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,461.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,461.25
|
|
|
HC STNT WALL CAROTID
|
Facility
|
IP
|
$6,425.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909000023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,084.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,582.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,582.85
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Cash Price |
$3,533.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,955.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,469.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,974.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,974.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,212.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,212.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,212.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,606.25
|
| Rate for Payer: Multiplan Commercial |
$4,818.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,321.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,127.32
|
|
|
HC STNT WALL RP BILRY W/UNI 20,40
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,719.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,277.33
|
| Rate for Payer: Blue Shield of California EPN |
$2,277.33
|
| Rate for Payer: Cash Price |
$3,115.75
|
| Rate for Payer: Cash Price |
$3,115.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,605.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,059.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,622.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,622.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,832.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,832.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,832.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.25
|
| Rate for Payer: Multiplan Commercial |
$4,248.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,046.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,875.68
|
|
|
HC STNT WALL RP BILRY W/UNI 20,40
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,719.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,891.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,115.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,248.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,277.33
|
| Rate for Payer: Blue Shield of California EPN |
$2,277.33
|
| Rate for Payer: Cash Price |
$3,115.75
|
| Rate for Payer: Cash Price |
$3,115.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,605.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,815.25
|
| Rate for Payer: Dignity Health Senior |
$4,815.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,625.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,622.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,622.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,832.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,832.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,832.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,965.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,965.50
|
| Rate for Payer: Multiplan Commercial |
$4,248.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,046.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,875.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,815.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,815.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,815.25
|
|
|
HC STNT WALL RP BILRY W/UNI 80,94
|
Facility
|
OP
|
$2,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$565.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,356.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,940.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,553.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,118.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,135.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,135.65
|
| Rate for Payer: Cash Price |
$1,553.75
|
| Rate for Payer: Cash Price |
$1,553.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,299.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,401.25
|
| Rate for Payer: Dignity Health Senior |
$2,401.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,808.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,307.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,307.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,412.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,412.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,412.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,977.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,977.50
|
| Rate for Payer: Multiplan Commercial |
$2,118.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,020.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$935.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,401.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,401.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,401.25
|
|
|
HC STNT WALL RP BILRY W/UNI 80,94
|
Facility
|
IP
|
$2,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$565.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,356.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,135.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,135.65
|
| Rate for Payer: Cash Price |
$1,553.75
|
| Rate for Payer: Cash Price |
$1,553.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,299.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,525.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,307.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,307.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,412.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,412.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,412.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.25
|
| Rate for Payer: Multiplan Commercial |
$2,118.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,020.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$935.36
|
|
|
HC STOMACH PROCEDURE, G TUBE
|
Facility
|
IP
|
$3,988.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743991
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$721.83 |
| Max. Negotiated Rate |
$2,991.00 |
| Rate for Payer: Adventist Health Commercial |
$797.60
|
| Rate for Payer: Cash Price |
$2,193.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,699.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,699.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.00
|
| Rate for Payer: Multiplan Commercial |
$2,991.00
|
|
|
HC STOMACH PROCEDURE, G TUBE
|
Facility
|
OP
|
$3,988.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743991
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$797.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,739.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,193.40
|
| Rate for Payer: Cash Price |
$2,193.40
|
| Rate for Payer: Cash Price |
$2,193.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,592.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,468.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,902.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$2,991.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC STRAIGHT PUSHABLE COIL
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
909081804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$278.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$233.16
|
| Rate for Payer: Blue Shield of California EPN |
$233.16
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$266.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.54
|
| Rate for Payer: Heritage Provider Network Senior |
$268.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$209.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$192.04
|
|
|
HC STRAIGHT PUSHABLE COIL
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
909081804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$278.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$233.16
|
| Rate for Payer: Blue Shield of California EPN |
$233.16
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$266.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Senior |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.54
|
| Rate for Payer: Heritage Provider Network Senior |
$268.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$209.55
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$192.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC STRAPPING ANKLE
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
900419072
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$270.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$352.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$453.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$429.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Senior |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$200.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.54
|
| Rate for Payer: Heritage Provider Network Senior |
$408.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$314.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.62
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC STRAPPING ANKLE
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
900419072
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$446.82
|
| Rate for Payer: Heritage Provider Network Senior |
$446.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.00
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
|
|
HC STRAPPING ANKLE
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
900501219
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$352.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$453.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$429.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Senior |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$200.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$446.82
|
| Rate for Payer: Heritage Provider Network Senior |
$446.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$314.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.62
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$237.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$218.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC STRAPPING ANKLE
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
900501219
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.46 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$446.82
|
| Rate for Payer: Heritage Provider Network Senior |
$446.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.00
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
|
|
HC STRAPPING ELBOW OR WRIST
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
901301209
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$45.83 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$309.14
|
| Rate for Payer: Aetna of CA Gatekeeper |
$403.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$518.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$414.70
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$490.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.73
|
| Rate for Payer: Heritage Provider Network Senior |
$466.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$359.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$565.50
|
| 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 |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC STRAPPING ELBOW OR WRIST
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
901301209
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$136.47 |
| Max. Negotiated Rate |
$565.50 |
| Rate for Payer: Adventist Health Commercial |
$150.80
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$510.46
|
| Rate for Payer: Heritage Provider Network Senior |
$510.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.50
|
| Rate for Payer: Multiplan Commercial |
$565.50
|
|
|
HC STRAPPING HAND OR FINGER
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
901301210
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$127.61 |
| Max. Negotiated Rate |
$528.75 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.29
|
| Rate for Payer: Heritage Provider Network Senior |
$477.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.25
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
|
|
HC STRAPPING HAND OR FINGER
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
901301210
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$75.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$289.05
|
| Rate for Payer: Aetna of CA Gatekeeper |
$376.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$484.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$387.75
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$458.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Senior |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$436.39
|
| Rate for Payer: Heritage Provider Network Senior |
$436.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$336.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.09
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
| 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 |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC STRAPPING HAND OR FINGER
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
900501366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.61 |
| Max. Negotiated Rate |
$528.75 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.29
|
| Rate for Payer: Heritage Provider Network Senior |
$477.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.25
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
|
