|
HC STNT BILRY SMRT CORD NITINL 80
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,731.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,577.80
|
| Rate for Payer: Blue Shield of California EPN |
$3,577.80
|
| 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 |
$4,120.70
|
| Rate for Payer: Heritage Provider Network Senior |
$4,120.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,450.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,450.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$3,215.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,946.79
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,500.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,895.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,675.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,577.80
|
| Rate for Payer: Blue Shield of California EPN |
$3,577.80
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$4,450.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,450.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,450.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,225.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,230.00
|
| Rate for Payer: Multiplan Commercial |
$6,675.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,215.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,946.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,565.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,565.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,565.00
|
|
|
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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| 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 |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
|
|
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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,410.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,567.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,567.80
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,409.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,291.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
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: Aetna of CA Non-Gatekeeper |
$4,434.58
|
| Rate for Payer: Cash Price |
$3,098.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,661.82
|
| Rate for Payer: Heritage Provider Network Senior |
$4,661.82
|
| Rate for Payer: Kaiser Foundation Hospitals 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 PLCMT CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$6,886.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
909036908
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,377.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,255.55
|
| 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 |
$5,158.00
|
| 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 |
$3,098.70
|
| Rate for Payer: Cash Price |
$3,098.70
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$3,284.62
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$1,884.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,066.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$4,361.46
|
| Rate for Payer: Heritage Provider Network Senior |
$4,361.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,710.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,710.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,884.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,821.56
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$4,710.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,710.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,970.65
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$3,212.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,212.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$1,285.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,137.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$2,974.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,974.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,212.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,212.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,648.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$2,622.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,622.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,832.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,832.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,133.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,500.97
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$2,832.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,832.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
IP
|
$2,825.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
909081427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Cash Price |
$1,271.25
|
| Rate for Payer: Adventist Health Commercial |
$565.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,819.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$1,271.25
|
| 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 |
$1,307.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,307.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,412.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,412.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$565.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,745.85
|
| 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 |
$13,770.00
|
| 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 |
$1,271.25
|
| 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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$1,412.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,412.50
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 STOMACH PROCEDURE, G TUBE
|
Facility
|
OP
|
$3,988.00
|
|
|
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 |
$797.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,464.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,994.80
|
| 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 |
$1,794.60
|
| Rate for Payer: Cash Price |
$1,794.60
|
| Rate for Payer: Cash Price |
$1,794.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,592.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,468.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,902.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$721.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| 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 |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
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: Aetna of CA Non-Gatekeeper |
$2,568.27
|
| Rate for Payer: Cash Price |
$1,794.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,699.88
|
| Rate for Payer: Heritage Provider Network Senior |
$2,699.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$721.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.00
|
| Rate for Payer: Multiplan Commercial |
$2,991.00
|
|
|
HC STRAIGHT PUSHABLE COIL
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
909081804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$358.44
|
| 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 |
$13,770.00
|
| 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 |
$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 Medicare Advantage |
$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 Foundation Hospitals Commercial |
$290.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$290.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 STRAIGHT PUSHABLE COIL
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
909081804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$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 |
$268.54
|
| Rate for Payer: Heritage Provider Network Senior |
$268.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$290.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$425.04
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$446.82
|
| Rate for Payer: Heritage Provider Network Senior |
$446.82
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
900419072
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$270.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$429.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$209.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.54
|
| Rate for Payer: Heritage Provider Network Senior |
$408.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$314.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| 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 |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
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: Aetna of CA Non-Gatekeeper |
$425.04
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$446.82
|
| Rate for Payer: Heritage Provider Network Senior |
$446.82
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$407.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$313.50
|
| Rate for Payer: Blue Shield of California EPN |
$249.48
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$429.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$209.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$446.82
|
| Rate for Payer: Heritage Provider Network Senior |
$446.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$314.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$495.00
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$396.00
|
| Rate for Payer: TriValley Medical Group Senior |
$396.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC 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: Aetna of CA Non-Gatekeeper |
$485.58
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$510.46
|
| Rate for Payer: Heritage Provider Network Senior |
$510.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.50
|
| Rate for Payer: Multiplan Commercial |
$565.50
|
|
|
HC STRAPPING ELBOW OR WRIST
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
901301209
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$75.87 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$309.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$465.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cash Price |
$339.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$490.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$75.87
|
| 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) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$359.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| 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 |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
