|
HC STNT COATED/COVERED W DELIVER
|
Facility
OP
|
$8,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,272.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,114.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,565.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,895.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,526.90
|
| Rate for Payer: Blue Shield of California EPN |
$5,224.30
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,094.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,565.00
|
| Rate for Payer: Dignity Health Senior |
$7,565.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,696.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,120.70
|
| Rate for Payer: Heritage Provider Network Senior |
$4,120.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,450.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,450.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,450.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,225.00
|
| Rate for Payer: Multiplan Commercial |
$6,675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,244.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,973.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,565.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,565.00
|
|
|
HC STNT COATED/COVERED W DELIVER
|
Facility
IP
|
$8,900.00
|
|
|
Service Code
|
CPT C1874
|
| Hospital Charge Code |
909081446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,780.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,272.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,114.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cash Price |
$4,005.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,094.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,806.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,025.30
|
| Rate for Payer: Heritage Provider Network Senior |
$6,025.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,450.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,450.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,450.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,225.00
|
| Rate for Payer: Multiplan Commercial |
$6,675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,244.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,973.49
|
|
|
HC STNT NO COAT/COVER W DEL SYS
|
Facility
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC STNT NO COAT/COVER W DEL SYS
|
Facility
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
OP
|
$8,527.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
906820283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,705.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,858.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,247.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,689.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,395.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,542.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,247.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,247.95
|
| Rate for Payer: Dignity Health Senior |
$7,247.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,278.21
|
| Rate for Payer: Heritage Provider Network Senior |
$5,278.21
|
| Rate for Payer: IEHP Medi-Cal |
$3,872.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,110.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,543.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,131.75
|
| Rate for Payer: Multiplan Commercial |
$6,395.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,247.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7,247.95
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
OP
|
$10,324.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,064.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,092.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,775.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,678.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,743.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$4,645.80
|
| Rate for Payer: Cash Price |
$4,645.80
|
| Rate for Payer: Cash Price |
$4,645.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,710.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,775.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,775.40
|
| Rate for Payer: Dignity Health Senior |
$8,775.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,390.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6,390.56
|
| Rate for Payer: IEHP Medi-Cal |
$3,872.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,976.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,868.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.00
|
| Rate for Payer: Multiplan Commercial |
$7,743.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,775.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,775.40
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
IP
|
$8,527.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
906820283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,543.39 |
| Max. Negotiated Rate |
$6,395.25 |
| Rate for Payer: Adventist Health Commercial |
$1,705.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,858.05
|
| Rate for Payer: Cash Price |
$3,837.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,772.78
|
| Rate for Payer: Heritage Provider Network Senior |
$5,772.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,543.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,131.75
|
| Rate for Payer: Multiplan Commercial |
$6,395.25
|
|
|
HC STNT PLCMT CNTRL DIALYSIS SEG
|
Facility
IP
|
$10,324.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,868.64 |
| Max. Negotiated Rate |
$7,743.00 |
| Rate for Payer: Adventist Health Commercial |
$2,064.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,092.59
|
| Rate for Payer: Cash Price |
$4,645.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,989.35
|
| Rate for Payer: Heritage Provider Network Senior |
$6,989.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,868.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,581.00
|
| Rate for Payer: Multiplan Commercial |
$7,743.00
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$4,239.00
|
| Rate for Payer: Cash Price |
$4,239.00
|
| 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 |
$6,377.34
|
| Rate for Payer: Heritage Provider Network Senior |
$6,377.34
|
| 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 |
$3,434.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,147.22
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$8,007.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,181.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,065.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,849.82
|
| Rate for Payer: Blue Shield of California EPN |
$5,529.54
|
| Rate for Payer: Cash Price |
$4,239.00
|
| Rate for Payer: Cash Price |
$4,239.00
|
| 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: Multiplan Commercial |
$7,065.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,434.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,147.22
|
| 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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$5,461.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,533.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,818.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,989.92
|
| Rate for Payer: Blue Shield of California EPN |
$3,771.48
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: Cash Price |
$2,891.25
|
| 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: Multiplan Commercial |
$4,818.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,342.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,146.59
|
| 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,891.25
|
| Rate for Payer: Cash Price |
$2,891.25
|
| 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 |
$4,349.72
|
| Rate for Payer: Heritage Provider Network Senior |
$4,349.72
|
| 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 |
$2,342.56
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,146.59
|
|
|
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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cash Price |
$2,549.25
|
| 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 |
$3,835.20
|
| Rate for Payer: Heritage Provider Network Senior |
$3,835.20
|
| 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 |
$2,065.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,892.68
|
|
|
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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$4,815.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,115.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,248.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.96
|
| Rate for Payer: Blue Shield of California EPN |
$3,325.36
|
| Rate for Payer: Cash Price |
$2,549.25
|
| Rate for Payer: Cash Price |
$2,549.25
|
| 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 |
$2,622.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,622.90
|
| 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 |
$2,065.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,892.68
|
| 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 |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$2,401.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,553.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,118.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,754.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,658.28
|
| Rate for Payer: Cash Price |
$1,271.25
|
| Rate for Payer: Cash Price |
$1,271.25
|
| 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 |
$1,307.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,307.98
|
| 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 |
$1,030.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$943.83
|
| 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 |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,271.25
|
| Rate for Payer: Cash Price |
$1,271.25
|
| 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 |
$1,912.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,912.52
|
| 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 |
$1,030.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$943.83
|
|
|
HC STOMACH PROCEDURE, G TUBE
|
Facility
OP
|
$3,016.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743991
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$603.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,071.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,960.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,866.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$545.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$2,262.00
|
| 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 |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC STOMACH PROCEDURE, G TUBE
|
Facility
IP
|
$3,016.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743991
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$545.90 |
| Max. Negotiated Rate |
$2,262.00 |
| Rate for Payer: Adventist Health Commercial |
$603.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,071.99
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,041.83
|
| Rate for Payer: Heritage Provider Network Senior |
$2,041.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$545.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.00
|
| Rate for Payer: Multiplan Commercial |
$2,262.00
|
|
|
HC STRAIGHT PUSHABLE COIL
|
Facility
IP
|
$580.00
|
|
| Hospital Charge Code |
909081804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$12,173.00 |
| 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: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| 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 |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| 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 |
$211.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$193.78
|
|
|
HC STRAIGHT PUSHABLE COIL
|
Facility
OP
|
$580.00
|
|
| Hospital Charge Code |
909081804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$12,139.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$360.18
|
| Rate for Payer: Blue Shield of California EPN |
$340.46
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| 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: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$211.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$193.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC STRAPPING ANKLE
|
Facility
OP
|
$604.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
900419072
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$271.80
|
| 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 |
$295.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: Dignity Health Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$196.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.88
|
| Rate for Payer: Heritage Provider Network Senior |
$373.88
|
| Rate for Payer: Humana Medicare |
$196.87
|
| Rate for Payer: IEHP Medi-Cal |
$39.95
|
| Rate for Payer: IEHP Medicare Advantage |
$196.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$374.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$232.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.06
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| 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 |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC STRAPPING ANKLE
|
Facility
IP
|
$604.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
900419072
|
|
Hospital Revenue Code
|
420
|
| 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 |
$414.95
|
| 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 Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
|
|
HC STRAPPING ANKLE
|
Facility
OP
|
$604.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
900501219
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$49.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$120.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$49.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$414.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$295.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: Dignity Health Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$196.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.91
|
| Rate for Payer: Heritage Provider Network Senior |
$408.91
|
| Rate for Payer: Humana Medicare |
$196.87
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$196.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$291.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$232.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.06
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$219.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$201.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC STRAPPING ANKLE
|
Facility
IP
|
$604.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
900501219
|
|
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 |
$414.95
|
| 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 Permanente of CA Medi-Cal |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.00
|
| Rate for Payer: Multiplan Commercial |
$453.00
|
|
|
HC STRAPPING ELBOW OR WRIST
|
Facility
OP
|
$890.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
901301209
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$178.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$76.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$611.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$578.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$76.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.91
|
| Rate for Payer: Heritage Provider Network Senior |
$550.91
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$44.13
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.29
|
| Rate for Payer: Multiplan Commercial |
$667.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
