|
HC WHFO OPPENHEIMER OT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
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 OPPENHEIMER OT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
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 WRIST GAUNTLET MOLDED
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
901309100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$311.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$364.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$522.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$646.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$418.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$570.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$305.52
|
| Rate for Payer: Blue Shield of California EPN |
$305.52
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$646.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$646.00
|
| Rate for Payer: Dignity Health Senior |
$646.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.88
|
| Rate for Payer: Heritage Provider Network Senior |
$351.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$502.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$380.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$380.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$532.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$532.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$274.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$646.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$646.00
|
| Rate for Payer: Vantage Medical Group Senior |
$646.00
|
|
|
HC WHFO WRIST GAUNTLET MOLDED
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
901309100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$152.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$364.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$305.52
|
| Rate for Payer: Blue Shield of California EPN |
$305.52
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$349.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$351.88
|
| Rate for Payer: Heritage Provider Network Senior |
$351.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$380.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$380.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$274.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$251.64
|
|
|
HC WHFO WRIST GAUNT W/THUMB SPIC
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Adventist Health Commercial |
$383.76
|
| Rate for Payer: Aetna of CA Gatekeeper |
$500.29
|
| 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 |
$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 |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$608.40
|
| 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 |
$608.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$579.38
|
| Rate for Payer: Heritage Provider Network Senior |
$579.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$272.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$446.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.42
|
| 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: 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 |
$795.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$795.60
|
| Rate for Payer: Vantage Medical Group Senior |
$795.60
|
|
|
HC WHFO WRIST GAUNT W/THUMB SPIC
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$169.42 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$187.20
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$633.67
|
| Rate for Payer: Heritage Provider Network Senior |
$633.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$702.00
|
|
|
HC WHIRLPOOL MCAL
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.63
|
| Rate for Payer: Heritage Provider Network Senior |
$172.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
|
|
HC WHIRLPOOL MCAL
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$104.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$136.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.25
|
| 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 |
$140.25
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Senior |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$121.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$178.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| 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 |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC WHIRLPOOL MCARE COM
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$104.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$136.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.25
|
| 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 |
$140.25
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Senior |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$121.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$178.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| 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 |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC WHIRLPOOL MCARE COM
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.63
|
| Rate for Payer: Heritage Provider Network Senior |
$172.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
|
|
HC WHIRLPOOL OT
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
903207022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.63
|
| Rate for Payer: Heritage Provider Network Senior |
$172.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
|
|
HC WHIRLPOOL OT
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
903207022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$104.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$136.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.25
|
| 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 |
$140.25
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Senior |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$121.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$178.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| 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 |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC WHIRLPOOL PT
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
905103118
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.63
|
| Rate for Payer: Heritage Provider Network Senior |
$172.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
|
|
HC WHIRLPOOL PT
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
905103118
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$104.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$136.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.25
|
| 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 |
$140.25
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Senior |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$121.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$178.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| 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 |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC WHIRLPOOL PT
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900419063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$51.00
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$172.63
|
| Rate for Payer: Heritage Provider Network Senior |
$172.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
|
|
HC WHIRLPOOL PT
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900419063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$354.00 |
| Rate for Payer: Adventist Health Commercial |
$104.55
|
| Rate for Payer: Aetna of CA Gatekeeper |
$136.30
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$175.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.25
|
| 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 |
$140.25
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cash Price |
$140.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$165.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.75
|
| Rate for Payer: Dignity Health Senior |
$216.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$157.84
|
| Rate for Payer: Heritage Provider Network Senior |
$157.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$121.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$178.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$191.25
|
| 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 |
$216.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.75
|
| Rate for Payer: Vantage Medical Group Senior |
$216.75
|
|
|
HC WHITAKER TEST
|
Facility
|
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
909000169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,163.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$931.70
|
| Rate for Payer: Cash Price |
$931.70
|
| Rate for Payer: Cash Price |
$931.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,101.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Senior |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$848.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,048.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,043.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,611.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$975.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,068.59
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$932.90
|
| Rate for Payer: TriValley Medical Group Senior |
$932.90
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
HC WHITAKER TEST
|
Facility
|
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 50396
|
| Hospital Charge Code |
909000169
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.61 |
| Max. Negotiated Rate |
$1,270.50 |
| Rate for Payer: Adventist Health Commercial |
$338.80
|
| Rate for Payer: Cash Price |
$931.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,146.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,146.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$1,270.50
|
|
|
HC WHITE CAP 15MM
|
Facility
|
IP
|
$44.69
|
|
| Hospital Charge Code |
900800856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Cash Price |
$24.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.26
|
| Rate for Payer: Heritage Provider Network Senior |
$30.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.17
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
|
|
HC WHITE CAP 15MM
|
Facility
|
OP
|
$44.69
|
|
| Hospital Charge Code |
900800856
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$37.99 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.89
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.52
|
| Rate for Payer: Blue Shield of California Commercial |
$27.26
|
| Rate for Payer: Blue Shield of California EPN |
$21.81
|
| Rate for Payer: Cash Price |
$24.58
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.99
|
| Rate for Payer: Dignity Health Senior |
$37.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.66
|
| Rate for Payer: Heritage Provider Network Senior |
$27.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.28
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.99
|
| Rate for Payer: Vantage Medical Group Senior |
$37.99
|
|
|
HC WINDOWING OF CAST
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$316.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$407.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Senior |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$200.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.62
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$213.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$196.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC WINDOWING OF CAST
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
900501355
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Cash Price |
$326.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC WIRE INDIGO SEPERATOR
|
Facility
|
OP
|
$2,913.00
|
|
|
Service Code
|
CPT C1759
|
| Hospital Charge Code |
909000017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,398.24
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,602.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,184.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,171.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,171.03
|
| Rate for Payer: Cash Price |
$1,602.15
|
| Rate for Payer: Cash Price |
$1,602.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,339.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,476.05
|
| Rate for Payer: Dignity Health Senior |
$2,476.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,864.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,348.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,348.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,456.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,456.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,456.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,039.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,039.10
|
| Rate for Payer: Multiplan Commercial |
$2,184.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,052.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$964.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,476.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,476.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,476.05
|
|
|
HC WIRE INDIGO SEPERATOR
|
Facility
|
IP
|
$2,913.00
|
|
|
Service Code
|
CPT C1759
|
| Hospital Charge Code |
909000017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.60 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$582.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,398.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,171.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,171.03
|
| Rate for Payer: Cash Price |
$1,602.15
|
| Rate for Payer: Cash Price |
$1,602.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,339.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,573.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,348.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,348.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,456.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,456.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,456.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.25
|
| Rate for Payer: Multiplan Commercial |
$2,184.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,052.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$964.49
|
|
|
HC WOUND EXPLORATION ABDOMEN/BACK
|
Facility
|
IP
|
$6,402.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
900501349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,158.76 |
| Max. Negotiated Rate |
$4,801.50 |
| Rate for Payer: Adventist Health Commercial |
$1,280.40
|
| Rate for Payer: Cash Price |
$3,521.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,334.15
|
| Rate for Payer: Heritage Provider Network Senior |
$4,334.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,158.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,600.50
|
| Rate for Payer: Multiplan Commercial |
$4,801.50
|
|
