|
HC WET MOUNT
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.73
|
| Rate for Payer: Blue Shield of California Commercial |
$33.32
|
| Rate for Payer: Blue Shield of California EPN |
$26.05
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| 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 |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.80
|
| Rate for Payer: Heritage Provider Network Senior |
$123.80
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: IEHP Medi-Cal |
$5.55
|
| Rate for Payer: IEHP Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| 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 |
$150.00
|
| 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
IP
|
$200.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC WET MOUNT
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12.43
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$130.00
|
| 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 |
$130.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$96.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| 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 |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$72.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$66.82
|
| 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
|
$200.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$137.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$135.40
|
| Rate for Payer: Heritage Provider Network Senior |
$135.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.36
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.70
|
| Rate for Payer: Heritage Provider Network Senior |
$111.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$140.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.25
|
| Rate for Payer: Dignity Health Senior |
$140.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.14
|
| Rate for Payer: Heritage Provider Network Senior |
$102.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Vantage Medical Group Senior |
$140.25
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$88.50 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.89
|
| Rate for Payer: Heritage Provider Network Senior |
$79.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$88.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$76.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: Dignity Health Senior |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.04
|
| Rate for Payer: Heritage Provider Network Senior |
$73.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$56.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC WHEELCHAIR MGMT 15 MIN PT COMM MCARE
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900417542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.36
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.70
|
| Rate for Payer: Heritage Provider Network Senior |
$111.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
|
|
HC WHEELCHAIR MGMT 15 MIN PT COMM MCARE
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900417542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$140.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$90.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.25
|
| Rate for Payer: Dignity Health Senior |
$140.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.14
|
| Rate for Payer: Heritage Provider Network Senior |
$102.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$79.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.25
|
| Rate for Payer: Vantage Medical Group Senior |
$140.25
|
|
|
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 |
$28.20 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$77.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$87.56
|
| Rate for Payer: Blue Shield of California EPN |
$82.77
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| 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: IEHP Medi-Cal |
$102.63
|
| 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 |
$51.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$47.11
|
| 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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$67.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$96.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| 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 |
$95.46
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| 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 |
$51.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$47.11
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$293.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.00
|
| 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 |
$364.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$346.64
|
| Rate for Payer: Heritage Provider Network Senior |
$346.64
|
| Rate for Payer: IEHP Medi-Cal |
$229.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$269.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group 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
|
430
|
| Min. Negotiated Rate |
$101.36 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.72
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.12
|
| Rate for Payer: Heritage Provider Network Senior |
$379.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
|
|
HC WHFO LONG OPPONENS WO ATTACH
|
Facility
OP
|
$936.00
|
|
|
Service Code
|
CPT L3808
|
| Hospital Charge Code |
901309111
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Adventist Health Commercial |
$187.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$533.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$643.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$514.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$702.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| 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: IEHP Medi-Cal |
$262.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$451.15
|
| 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
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group 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
|
430
|
| Min. Negotiated Rate |
$169.42 |
| Max. Negotiated Rate |
$702.00 |
| Rate for Payer: Adventist Health Commercial |
$187.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$643.03
|
| Rate for Payer: Cash Price |
$421.20
|
| 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 WHFO OPPENHEIMER OT
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$101.36 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.72
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$379.12
|
| Rate for Payer: Heritage Provider Network Senior |
$379.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
|
|
HC WHFO OPPENHEIMER OT
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$293.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$384.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$364.00
|
| 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 |
$364.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$346.64
|
| Rate for Payer: Heritage Provider Network Senior |
$346.64
|
| Rate for Payer: IEHP Medi-Cal |
$229.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$269.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC WHFO WRIST GAUNTLET MOLDED
|
Facility
IP
|
$760.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
901309100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Adventist Health Commercial |
$152.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$522.12
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$514.52
|
| Rate for Payer: Heritage Provider Network Senior |
$514.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
|
|
HC WHFO WRIST GAUNTLET MOLDED
|
Facility
OP
|
$760.00
|
|
|
Service Code
|
CPT L3906
|
| Hospital Charge Code |
901309100
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$646.00 |
| Rate for Payer: Adventist Health Commercial |
$152.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$636.36
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$522.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$646.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$418.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$570.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$494.00
|
| 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 |
$494.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$470.44
|
| Rate for Payer: Heritage Provider Network Senior |
$470.44
|
| Rate for Payer: IEHP Medi-Cal |
$484.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$366.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.00
|
| Rate for Payer: Multiplan Commercial |
$570.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$646.00
|
| Rate for Payer: Vantage Medical Group Senior |
$646.00
|
|
|
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 |
$187.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$533.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$643.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$795.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$514.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$702.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| 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: IEHP Medi-Cal |
$262.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$451.15
|
| 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
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group 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: Aetna of CA Non-Gatekeeper |
$643.03
|
| Rate for Payer: Cash Price |
$421.20
|
| 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
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.44
|
| Rate for Payer: Heritage Provider Network Senior |
$181.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
|
|
HC WHIRLPOOL MCAL
|
Facility
OP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
901300045
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$33.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$201.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$174.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Senior |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.89
|
| Rate for Payer: Heritage Provider Network Senior |
$165.89
|
| Rate for Payer: IEHP Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$129.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC WHIRLPOOL MCARE COM
|
Facility
IP
|
$268.00
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
900407040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.12
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.44
|
| Rate for Payer: Heritage Provider Network Senior |
$181.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.00
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
|
