|
HC ABD PARACENTESIS W IMAGE GUID
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
906749080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$373.22 |
| Max. Negotiated Rate |
$1,546.50 |
| Rate for Payer: Adventist Health Commercial |
$412.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.59
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.50
|
| Rate for Payer: Multiplan Commercial |
$1,546.50
|
|
|
HC ABD PARACENTESIS W IMAGE GUID
|
Facility
|
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
906749080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$373.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$412.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,340.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,276.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$1,546.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,245.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,245.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ABD PARACENTESIS W IMAG GUID
|
Facility
|
IP
|
$1,637.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
901249083
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$296.30 |
| Max. Negotiated Rate |
$1,227.75 |
| Rate for Payer: Adventist Health Commercial |
$327.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,124.62
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,108.25
|
| Rate for Payer: Heritage Provider Network Senior |
$1,108.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.25
|
| Rate for Payer: Multiplan Commercial |
$1,227.75
|
|
|
HC ABD PARACENTESIS W IMAG GUID
|
Facility
|
OP
|
$1,637.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
901249083
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$296.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$327.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,124.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,016.58
|
| Rate for Payer: Blue Shield of California EPN |
$960.92
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cash Price |
$736.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,064.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,013.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,013.30
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$1,227.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,245.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,132.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ABD PARACENTESIS WO IMAGE GUID
|
Facility
|
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
906749081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$412.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,340.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,276.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$1,546.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,245.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,245.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ABD PARACENTESIS WO IMAGE GUID
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
906749081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$373.22 |
| Max. Negotiated Rate |
$1,546.50 |
| Rate for Payer: Adventist Health Commercial |
$412.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,416.59
|
| Rate for Payer: Cash Price |
$927.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,395.97
|
| Rate for Payer: Heritage Provider Network Senior |
$1,395.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.50
|
| Rate for Payer: Multiplan Commercial |
$1,546.50
|
|
|
HC ABD PARACENTESIS WO IMAGE GUIDE
|
Facility
|
OP
|
$2,183.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901249082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$436.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,499.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,418.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,351.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$395.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$545.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$1,637.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,245.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,245.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ABD PARACENTESIS WO IMAGE GUIDE
|
Facility
|
IP
|
$2,183.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901249082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$1,637.25 |
| Rate for Payer: Adventist Health Commercial |
$436.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,499.72
|
| Rate for Payer: Cash Price |
$982.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,477.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,477.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$395.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$545.75
|
| Rate for Payer: Multiplan Commercial |
$1,637.25
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
|
OP
|
$2,251.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
906820173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$450.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,546.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,913.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,238.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,688.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,463.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,913.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,913.35
|
| Rate for Payer: Dignity Health Senior |
$1,913.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,393.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,084.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.75
|
| Rate for Payer: Multiplan Commercial |
$1,688.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,913.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,913.35
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
|
IP
|
$2,251.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
906820173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$407.43 |
| Max. Negotiated Rate |
$1,688.25 |
| Rate for Payer: Adventist Health Commercial |
$450.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,546.44
|
| Rate for Payer: Cash Price |
$1,012.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,523.93
|
| Rate for Payer: Heritage Provider Network Senior |
$1,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.75
|
| Rate for Payer: Multiplan Commercial |
$1,688.25
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
|
OP
|
$3,498.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
909081315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$699.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,403.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,973.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,923.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,623.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,273.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,973.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,973.30
|
| Rate for Payer: Dignity Health Senior |
$2,973.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,165.26
|
| Rate for Payer: Heritage Provider Network Senior |
$2,165.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,686.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.50
|
| Rate for Payer: Multiplan Commercial |
$2,623.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,973.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,973.30
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
|
IP
|
$3,498.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
909081315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$633.14 |
| Max. Negotiated Rate |
$2,623.50 |
| Rate for Payer: Adventist Health Commercial |
$699.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,403.13
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,368.15
|
| Rate for Payer: Heritage Provider Network Senior |
$2,368.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.50
|
| Rate for Payer: Multiplan Commercial |
$2,623.50
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
906820180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$523.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Senior |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.30
|
| Rate for Payer: Heritage Provider Network Senior |
$498.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$379.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$388.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
906820180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.70 |
| Max. Negotiated Rate |
$603.75 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.98
|
| Rate for Payer: Heritage Provider Network Senior |
$544.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
IP
|
$2,764.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
909081324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.28 |
| Max. Negotiated Rate |
$2,073.00 |
| Rate for Payer: Adventist Health Commercial |
$552.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,898.87
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,871.23
|
| Rate for Payer: Heritage Provider Network Senior |
$1,871.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$500.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.00
|
| Rate for Payer: Multiplan Commercial |
$2,073.00
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
OP
|
$2,764.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
909081324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$379.83 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$552.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,898.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,349.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,520.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,073.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cash Price |
$1,243.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,796.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,349.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,349.40
|
| Rate for Payer: Dignity Health Senior |
$2,349.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,710.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,710.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$379.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,332.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$500.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.00
|
| Rate for Payer: Multiplan Commercial |
$2,073.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,349.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,349.40
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$556.58 |
| Max. Negotiated Rate |
$2,306.25 |
| Rate for Payer: Adventist Health Commercial |
$615.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,112.52
|
| Rate for Payer: Cash Price |
$1,383.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,081.78
|
| Rate for Payer: Heritage Provider Network Senior |
$2,081.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.75
|
| Rate for Payer: Multiplan Commercial |
$2,306.25
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$451.85 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$615.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,112.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,613.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,691.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,306.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,383.75
|
| Rate for Payer: Cash Price |
$1,383.75
|
| Rate for Payer: Cash Price |
$1,383.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,998.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,613.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,613.75
|
| Rate for Payer: Dignity Health Senior |
$2,613.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,903.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,903.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$451.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,482.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$768.75
|
| Rate for Payer: Multiplan Commercial |
$2,306.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,613.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,613.75
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
906820181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$523.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: Dignity Health Senior |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$498.30
|
| Rate for Payer: Heritage Provider Network Senior |
$498.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$451.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$388.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
906820181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.70 |
| Max. Negotiated Rate |
$603.75 |
| Rate for Payer: Adventist Health Commercial |
$161.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$553.04
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.98
|
| Rate for Payer: Heritage Provider Network Senior |
$544.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.25
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
906820182
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$133.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$456.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$565.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$432.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$565.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.25
|
| Rate for Payer: Dignity Health Senior |
$565.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$411.64
|
| Rate for Payer: Heritage Provider Network Senior |
$411.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$320.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.25
|
| Rate for Payer: Multiplan Commercial |
$498.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.25
|
| Rate for Payer: Vantage Medical Group Senior |
$565.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
IP
|
$1,356.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.44 |
| Max. Negotiated Rate |
$1,017.00 |
| Rate for Payer: Adventist Health Commercial |
$271.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$931.57
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$918.01
|
| Rate for Payer: Heritage Provider Network Senior |
$918.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.00
|
| Rate for Payer: Multiplan Commercial |
$1,017.00
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
OP
|
$1,356.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$271.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$931.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,152.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$745.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,017.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$881.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,152.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,152.60
|
| Rate for Payer: Dignity Health Senior |
$1,152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$839.36
|
| Rate for Payer: Heritage Provider Network Senior |
$839.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$653.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.00
|
| Rate for Payer: Multiplan Commercial |
$1,017.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,152.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,152.60
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
906820182
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Adventist Health Commercial |
$133.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$456.86
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.20
|
| Rate for Payer: Heritage Provider Network Senior |
$450.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.25
|
| Rate for Payer: Multiplan Commercial |
$498.75
|
|
|
HC ABLAT CERV/THORAC EA ADD LEVEL
|
Facility
|
IP
|
$3,392.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$613.95 |
| Max. Negotiated Rate |
$2,544.00 |
| Rate for Payer: Adventist Health Commercial |
$678.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,330.30
|
| Rate for Payer: Cash Price |
$1,526.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,296.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,296.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$848.00
|
| Rate for Payer: Multiplan Commercial |
$2,544.00
|
|
