|
HC STRAPPING ELBOW OR WRIST
|
Facility
IP
|
$890.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
901301209
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$161.09 |
| Max. Negotiated Rate |
$667.50 |
| Rate for Payer: Adventist Health Commercial |
$178.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$611.43
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$602.53
|
| Rate for Payer: Heritage Provider Network Senior |
$602.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.50
|
| Rate for Payer: Multiplan Commercial |
$667.50
|
|
|
HC STRAPPING HAND OR FINGER
|
Facility
OP
|
$645.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
900501366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$129.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.12
|
| 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: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$419.25
|
| 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 |
$436.66
|
| Rate for Payer: Heritage Provider Network Senior |
$436.66
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$310.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.25
|
| 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 |
$483.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$234.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$215.49
|
| 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
|
|
|
HC STRAPPING HAND OR FINGER
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
901301210
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.35
|
| 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 |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$682.50
|
| 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 |
$649.95
|
| Rate for Payer: Heritage Provider Network Senior |
$649.95
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$81.31
|
| 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 |
$190.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.50
|
| 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 |
$787.50
|
| 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
|
|
|
HC STRAPPING HAND OR FINGER
|
Facility
IP
|
$645.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
900501366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.74 |
| Max. Negotiated Rate |
$483.75 |
| Rate for Payer: Adventist Health Commercial |
$129.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$443.12
|
| Rate for Payer: Cash Price |
$290.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$436.66
|
| Rate for Payer: Heritage Provider Network Senior |
$436.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.25
|
| Rate for Payer: Multiplan Commercial |
$483.75
|
|
|
HC STRAPPING HAND OR FINGER
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
901301210
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$190.05 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.35
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$710.85
|
| Rate for Payer: Heritage Provider Network Senior |
$710.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$787.50
|
|
|
HC STRAPPING, HIP
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 29520
|
| Hospital Charge Code |
900501627
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$74.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$197.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$181.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC STRAPPING, HIP
|
Facility
IP
|
$543.00
|
|
|
Service Code
|
CPT 29520
|
| Hospital Charge Code |
900501627
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$407.25 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
|
|
HC STRAPPING KNEE
|
Facility
IP
|
$249.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
900419071
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.07 |
| Max. Negotiated Rate |
$186.75 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.57
|
| Rate for Payer: Heritage Provider Network Senior |
$168.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
|
|
HC STRAPPING KNEE
|
Facility
OP
|
$249.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
900419071
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.07 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$154.13
|
| Rate for Payer: Heritage Provider Network Senior |
$154.13
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$46.46
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC STRAPPING KNEE
|
Facility
IP
|
$249.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
900501108
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.07 |
| Max. Negotiated Rate |
$186.75 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.57
|
| Rate for Payer: Heritage Provider Network Senior |
$168.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
|
|
HC STRAPPING KNEE
|
Facility
OP
|
$249.00
|
|
|
Service Code
|
CPT 29530
|
| Hospital Charge Code |
900501108
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.07 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.42
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.57
|
| Rate for Payer: Heritage Provider Network Senior |
$168.57
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$120.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC STRAPPING OF ELBOW OR WRIST
|
Facility
OP
|
$691.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
900501428
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$138.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$76.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$474.72
|
| 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: Cash Price |
$310.95
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$449.15
|
| 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 |
$467.81
|
| Rate for Payer: Heritage Provider Network Senior |
$467.81
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$333.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.75
|
| 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 |
$518.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$250.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$230.86
|
| 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
|
|
|
HC STRAPPING OF ELBOW OR WRIST
|
Facility
IP
|
$691.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
900501428
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.07 |
| Max. Negotiated Rate |
$518.25 |
| Rate for Payer: Adventist Health Commercial |
$138.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$474.72
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.81
|
| Rate for Payer: Heritage Provider Network Senior |
$467.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.75
|
| Rate for Payer: Multiplan Commercial |
$518.25
|
|
|
HC STRAPPING OF ELBOW OR WRIST MCAL
|
Facility
OP
|
$890.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
901300015
|
|
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
|
|
|
HC STRAPPING OF ELBOW OR WRIST MCAL
|
Facility
IP
|
$890.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
901300015
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$161.09 |
| Max. Negotiated Rate |
$667.50 |
| Rate for Payer: Adventist Health Commercial |
$178.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$611.43
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$602.53
|
| Rate for Payer: Heritage Provider Network Senior |
$602.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.50
|
| Rate for Payer: Multiplan Commercial |
$667.50
|
|
|
HC STRAPPING OF HAND OR FINGER MCAL
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
901300017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.35
|
| 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 |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$682.50
|
| 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 |
$649.95
|
| Rate for Payer: Heritage Provider Network Senior |
$649.95
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$81.31
|
| 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 |
$190.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.50
|
| 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 |
$787.50
|
| 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
|
|
|
HC STRAPPING OF HAND OR FINGER MCAL
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 29280
|
| Hospital Charge Code |
901300017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$190.05 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.35
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$710.85
|
| Rate for Payer: Heritage Provider Network Senior |
$710.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$787.50
|
|
|
HC STRAPPING OF SHOULDER
|
Facility
IP
|
$691.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
900501103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.07 |
| Max. Negotiated Rate |
$518.25 |
| Rate for Payer: Adventist Health Commercial |
$138.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$474.72
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.81
|
| Rate for Payer: Heritage Provider Network Senior |
$467.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.75
|
| Rate for Payer: Multiplan Commercial |
$518.25
|
|
|
HC STRAPPING OF SHOULDER
|
Facility
OP
|
$691.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
900501103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$138.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$89.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$474.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$449.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$467.81
|
| Rate for Payer: Heritage Provider Network Senior |
$467.81
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$333.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$518.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$250.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$230.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC STRAPPING OF SHOULDER MCAL
|
Facility
IP
|
$890.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
901300013
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$161.09 |
| Max. Negotiated Rate |
$667.50 |
| Rate for Payer: Adventist Health Commercial |
$178.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$611.43
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$602.53
|
| Rate for Payer: Heritage Provider Network Senior |
$602.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.50
|
| Rate for Payer: Multiplan Commercial |
$667.50
|
|
|
HC STRAPPING OF SHOULDER MCAL
|
Facility
OP
|
$890.00
|
|
|
Service Code
|
CPT 29240
|
| Hospital Charge Code |
901300013
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$178.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$89.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$611.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$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 |
$239.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: Dignity Health Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$159.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.91
|
| Rate for Payer: Heritage Provider Network Senior |
$550.91
|
| Rate for Payer: Humana Medicare |
$159.60
|
| Rate for Payer: IEHP Medi-Cal |
$55.75
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$303.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$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 |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC STRAPPING OF TOES
|
Facility
OP
|
$249.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
900419073
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| 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 |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.85
|
| 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 |
$154.13
|
| Rate for Payer: Heritage Provider Network Senior |
$154.13
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$26.13
|
| 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 |
$45.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| 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 |
$186.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC STRAPPING OF TOES
|
Facility
IP
|
$249.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
900419073
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.07 |
| Max. Negotiated Rate |
$186.75 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.57
|
| Rate for Payer: Heritage Provider Network Senior |
$168.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
|
|
HC STRAPPING OF TOES
|
Facility
OP
|
$249.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
900501307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$34.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$34.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| 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: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.85
|
| 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 |
$168.57
|
| Rate for Payer: Heritage Provider Network Senior |
$168.57
|
| Rate for Payer: Humana Medicare |
$76.42
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$120.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| 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 |
$186.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$90.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.19
|
| 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
|
|
|
HC STRAPPING OF TOES
|
Facility
IP
|
$249.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
900501307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.07 |
| Max. Negotiated Rate |
$186.75 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$171.06
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$168.57
|
| Rate for Payer: Heritage Provider Network Senior |
$168.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
|
