|
HC WASP VENOM IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
HC WEAK ACIDIC DRUG CONF & ID
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$562.57 |
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$333.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.57
|
| Rate for Payer: Blue Shield of California Commercial |
$459.71
|
| Rate for Payer: Blue Shield of California EPN |
$368.72
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$405.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$62.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$386.26
|
| Rate for Payer: Heritage Provider Network Senior |
$386.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$297.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.30
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$62.14
|
| Rate for Payer: TriValley Medical Group Senior |
$62.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$67.12
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$67.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC WEAK ACIDIC DRUG CONF & ID
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.94 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$422.45
|
| Rate for Payer: Heritage Provider Network Senior |
$422.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$134.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$463.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$370.70
|
| Rate for Payer: Cash Price |
$370.70
|
| Rate for Payer: Cash Price |
$370.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$438.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.30
|
| Rate for Payer: Heritage Provider Network Senior |
$456.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$321.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$505.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$242.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$223.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.99 |
| Max. Negotiated Rate |
$505.50 |
| Rate for Payer: Adventist Health Commercial |
$134.80
|
| Rate for Payer: Cash Price |
$370.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$456.30
|
| Rate for Payer: Heritage Provider Network Senior |
$456.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.50
|
| Rate for Payer: Multiplan Commercial |
$505.50
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$338.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$435.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$412.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Senior |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$337.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$302.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$388.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.19
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$228.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$475.50 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$429.22
|
| Rate for Payer: Heritage Provider Network Senior |
$429.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.50
|
| Rate for Payer: Multiplan Commercial |
$475.50
|
|
|
HC WEEKLY PHYSICS
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$238.20 |
| Max. Negotiated Rate |
$987.00 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$890.93
|
| Rate for Payer: Heritage Provider Network Senior |
$890.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.00
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
|
|
HC WEEKLY PHYSICS
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$89.23 |
| Max. Negotiated Rate |
$987.00 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$703.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$904.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$686.73
|
| Rate for Payer: Blue Shield of California Commercial |
$627.07
|
| Rate for Payer: Blue Shield of California EPN |
$504.27
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$855.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.57
|
| Rate for Payer: Dignity Health Senior |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$855.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$168.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$814.60
|
| Rate for Payer: Heritage Provider Network Senior |
$814.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$89.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$627.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$238.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$212.56
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$143.40
|
| Rate for Payer: TriValley Medical Group Senior |
$143.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$658.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$658.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Vantage Medical Group Senior |
$168.70
|
|
|
HC WET MOUNT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.97
|
| Rate for Payer: Blue Shield of California Commercial |
$34.33
|
| Rate for Payer: Blue Shield of California EPN |
$27.54
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.32
|
| Rate for Payer: Heritage Provider Network Senior |
$121.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.33
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.82
|
| Rate for Payer: TriValley Medical Group Senior |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.29
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC WET MOUNT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$104.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Senior |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$93.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.33
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$70.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$64.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC WET MOUNT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
|
|
HC WET MOUNT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$132.69
|
| Rate for Payer: Heritage Provider Network Senior |
$132.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$83.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Senior |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.18
|
| Rate for Payer: Heritage Provider Network Senior |
$97.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.29
|
| Rate for Payer: Heritage Provider Network Senior |
$106.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Adventist Health Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$52.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.31
|
| Rate for Payer: Heritage Provider Network Senior |
$64.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$38.95
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$52.25
|
| Rate for Payer: Cash Price |
$52.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$61.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.75
|
| Rate for Payer: Dignity Health Senior |
$80.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Senior |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.50
|
| Rate for Payer: Multiplan Commercial |
$71.25
|
| 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 |
$80.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.75
|
| Rate for Payer: Vantage Medical Group Senior |
$80.75
|
|
|
HC WHEELCHAIR MGMT 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900417542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Aetna of CA Gatekeeper |
$83.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.00
|
| 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 |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Senior |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.18
|
| Rate for Payer: Heritage Provider Network Senior |
$97.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHEELCHAIR MGMT 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900417542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.29
|
| Rate for Payer: Heritage Provider Network Senior |
$106.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
|
|
HC WHFO FINGER EXT W/CLOCK SPRIN
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$57.81
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$56.68
|
| Rate for Payer: Blue Shield of California EPN |
$56.68
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.85
|
| Rate for Payer: Dignity Health Senior |
$119.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.28
|
| Rate for Payer: Heritage Provider Network Senior |
$65.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.70
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.85
|
| Rate for Payer: Vantage Medical Group Senior |
$119.85
|
|
|
HC WHFO FINGER EXT W/CLOCK SPRIN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$56.68
|
| Rate for Payer: Blue Shield of California EPN |
$56.68
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cash Price |
$77.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$64.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.28
|
| Rate for Payer: Heritage Provider Network Senior |
$65.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$70.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.25
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$50.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$46.69
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$268.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$225.12
|
| Rate for Payer: Blue Shield of California EPN |
$225.12
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$257.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Senior |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$259.28
|
| Rate for Payer: Heritage Provider Network Senior |
$259.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$238.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$280.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$280.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$202.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$185.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$268.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$225.12
|
| Rate for Payer: Blue Shield of California EPN |
$225.12
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$257.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$259.28
|
| Rate for Payer: Heritage Provider Network Senior |
$259.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$280.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$280.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$202.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$185.42
|
|
|
HC WHFO LONG OPPONENS WO ATTACH
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309111
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$383.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$449.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$643.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$514.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$376.27
|
| Rate for Payer: Blue Shield of California EPN |
$376.27
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$430.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$795.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$795.60
|
| Rate for Payer: Dignity Health Senior |
$795.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$599.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.37
|
| Rate for Payer: Heritage Provider Network Senior |
$433.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$468.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$655.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$655.20
|
| Rate for Payer: Multiplan Commercial |
$702.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$338.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$309.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$795.60
|
| Rate for Payer: Vantage Medical Group Senior |
$795.60
|
|
|
HC WHFO LONG OPPONENS WO ATTACH
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309111
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$187.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$449.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$376.27
|
| Rate for Payer: Blue Shield of California EPN |
$376.27
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$430.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.37
|
| Rate for Payer: Heritage Provider Network Senior |
$433.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$468.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$702.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$338.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$309.91
|
|
