|
HC ATHRECTOMY TIBIOPERONEAL
|
Facility
|
IP
|
$26,298.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
909020070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,759.94 |
| Max. Negotiated Rate |
$19,723.50 |
| Rate for Payer: Adventist Health Commercial |
$5,259.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,066.73
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,803.75
|
| Rate for Payer: Heritage Provider Network Senior |
$17,803.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,759.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,574.50
|
| Rate for Payer: Multiplan Commercial |
$19,723.50
|
|
|
HC ATHRECTOMY TIBIOPERONEAL
|
Facility
|
IP
|
$28,001.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
906820153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,068.18 |
| Max. Negotiated Rate |
$21,000.75 |
| Rate for Payer: Adventist Health Commercial |
$5,600.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,236.69
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,956.68
|
| Rate for Payer: Heritage Provider Network Senior |
$18,956.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,068.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,000.25
|
| Rate for Payer: Multiplan Commercial |
$21,000.75
|
|
|
HC ATHRECTOMY TIBIOPERONEAL
|
Facility
|
OP
|
$26,298.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
909020070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$191.33 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$5,259.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,066.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,093.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,278.46
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,759.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,574.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$19,723.50
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC ATHRECTOMY TIBIOPERONEAL
|
Facility
|
OP
|
$28,001.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
906820153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$191.33 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$5,600.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,236.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,200.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,332.62
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$191.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,068.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,000.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$21,000.75
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC ATHRECTOMY TIBIOPERONEAL EA AD
|
Facility
|
OP
|
$26,298.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
909020074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.33 |
| Max. Negotiated Rate |
$22,353.30 |
| Rate for Payer: Adventist Health Commercial |
$5,259.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,066.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,353.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,463.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,723.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,093.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,353.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,353.30
|
| Rate for Payer: Dignity Health Senior |
$22,353.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,278.46
|
| Rate for Payer: Heritage Provider Network Senior |
$16,278.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,675.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,759.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,574.50
|
| Rate for Payer: Multiplan Commercial |
$19,723.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,353.30
|
| Rate for Payer: Vantage Medical Group Senior |
$22,353.30
|
|
|
HC ATHRECTOMY TIBIOPERONEAL EA AD
|
Facility
|
IP
|
$28,001.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
906820157
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,068.18 |
| Max. Negotiated Rate |
$21,000.75 |
| Rate for Payer: Adventist Health Commercial |
$5,600.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,236.69
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,956.68
|
| Rate for Payer: Heritage Provider Network Senior |
$18,956.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,068.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,000.25
|
| Rate for Payer: Multiplan Commercial |
$21,000.75
|
|
|
HC ATHRECTOMY TIBIOPERONEAL EA AD
|
Facility
|
OP
|
$28,001.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
906820157
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.33 |
| Max. Negotiated Rate |
$23,800.85 |
| Rate for Payer: Adventist Health Commercial |
$5,600.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,236.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,800.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,400.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,000.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cash Price |
$12,600.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,200.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,800.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,800.85
|
| Rate for Payer: Dignity Health Senior |
$23,800.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,332.62
|
| Rate for Payer: Heritage Provider Network Senior |
$17,332.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,496.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,068.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,000.25
|
| Rate for Payer: Multiplan Commercial |
$21,000.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,800.85
|
| Rate for Payer: Vantage Medical Group Senior |
$23,800.85
|
|
|
HC ATHRECTOMY TIBIOPERONEAL EA AD
|
Facility
|
IP
|
$26,298.00
|
|
|
Service Code
|
CPT 37233
|
| Hospital Charge Code |
909020074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,759.94 |
| Max. Negotiated Rate |
$19,723.50 |
| Rate for Payer: Adventist Health Commercial |
$5,259.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,066.73
|
| Rate for Payer: Cash Price |
$11,834.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,803.75
|
| Rate for Payer: Heritage Provider Network Senior |
$17,803.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,759.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,574.50
|
| Rate for Payer: Multiplan Commercial |
$19,723.50
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
|
IP
|
$32,366.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
906820161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,858.25 |
| Max. Negotiated Rate |
$24,274.50 |
| Rate for Payer: Adventist Health Commercial |
$6,473.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,235.44
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,911.78
|
| Rate for Payer: Heritage Provider Network Senior |
$21,911.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,858.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,091.50
|
| Rate for Payer: Multiplan Commercial |
$24,274.50
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
|
IP
|
$38,726.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
909020078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,009.41 |
| Max. Negotiated Rate |
$29,044.50 |
| Rate for Payer: Adventist Health Commercial |
$7,745.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,604.76
|
| Rate for Payer: Cash Price |
$17,426.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,217.50
|
| Rate for Payer: Heritage Provider Network Senior |
$26,217.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,009.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,681.50
|
| Rate for Payer: Multiplan Commercial |
$29,044.50
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
|
OP
|
$32,366.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
906820161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,841.00 |
| Max. Negotiated Rate |
$27,511.10 |
| Rate for Payer: Adventist Health Commercial |
$6,473.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,235.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27,511.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,801.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,274.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cash Price |
$14,564.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,037.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27,511.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,511.10
|
| Rate for Payer: Dignity Health Senior |
$27,511.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,419.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,034.55
|
| Rate for Payer: Heritage Provider Network Senior |
$20,034.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,600.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,858.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,091.50
|
| Rate for Payer: Multiplan Commercial |
$24,274.50
|
| 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 Medi-Cal |
$27,511.10
|
| Rate for Payer: Vantage Medical Group Senior |
$27,511.10
|
|
|
HC ATHRECTOMY VISCERAL
|
Facility
|
OP
|
$38,726.00
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
909020078
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,841.00 |
| Max. Negotiated Rate |
$32,917.10 |
| Rate for Payer: Adventist Health Commercial |
$7,745.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,604.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,917.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,299.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29,044.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$17,426.70
|
| Rate for Payer: Cash Price |
$17,426.70
|
| Rate for Payer: Cash Price |
$17,426.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,171.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,917.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,917.10
|
| Rate for Payer: Dignity Health Senior |
$32,917.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,235.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,971.39
|
| Rate for Payer: Heritage Provider Network Senior |
$23,971.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,665.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,009.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,681.50
|
| Rate for Payer: Multiplan Commercial |
$29,044.50
|
| 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 Medi-Cal |
$32,917.10
|
| Rate for Payer: Vantage Medical Group Senior |
$32,917.10
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
|
OP
|
$10,462.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906820317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$195.73 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,092.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,187.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,892.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,754.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,846.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| 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 |
$4,707.90
|
| Rate for Payer: Cash Price |
$4,707.90
|
| Rate for Payer: Cash Price |
$4,707.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,800.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,892.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,892.70
|
| Rate for Payer: Dignity Health Senior |
$8,892.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,475.98
|
| Rate for Payer: Heritage Provider Network Senior |
$6,475.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,042.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,893.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.50
|
| Rate for Payer: Multiplan Commercial |
$7,846.50
|
| 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 Medi-Cal |
$8,892.70
|
| Rate for Payer: Vantage Medical Group Senior |
$8,892.70
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
|
IP
|
$10,462.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906820317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,893.62 |
| Max. Negotiated Rate |
$7,846.50 |
| Rate for Payer: Adventist Health Commercial |
$2,092.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,187.39
|
| Rate for Payer: Cash Price |
$4,707.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,082.77
|
| Rate for Payer: Heritage Provider Network Senior |
$7,082.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,893.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.50
|
| Rate for Payer: Multiplan Commercial |
$7,846.50
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
|
OP
|
$9,586.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906811741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$195.73 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$1,917.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,585.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,148.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,272.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,189.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| 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 |
$4,313.70
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,230.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,148.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,148.10
|
| Rate for Payer: Dignity Health Senior |
$8,148.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,933.73
|
| Rate for Payer: Heritage Provider Network Senior |
$5,933.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,620.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,735.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,396.50
|
| Rate for Payer: Multiplan Commercial |
$7,189.50
|
| 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 Medi-Cal |
$8,148.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,148.10
|
|
|
HC ATRIAL BALLOON SEPTOSTOMY
|
Facility
|
IP
|
$9,586.00
|
|
|
Service Code
|
CPT 33741
|
| Hospital Charge Code |
906811741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,735.07 |
| Max. Negotiated Rate |
$7,189.50 |
| Rate for Payer: Adventist Health Commercial |
$1,917.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,585.58
|
| Rate for Payer: Cash Price |
$4,313.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,489.72
|
| Rate for Payer: Heritage Provider Network Senior |
$6,489.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,735.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,396.50
|
| Rate for Payer: Multiplan Commercial |
$7,189.50
|
|
|
HC AUD EP SCRN AP W/BB STIMULI AA
|
Facility
|
IP
|
$988.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
900600650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$178.83 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Adventist Health Commercial |
$197.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.76
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.88
|
| Rate for Payer: Heritage Provider Network Senior |
$668.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.00
|
| Rate for Payer: Multiplan Commercial |
$741.00
|
|
|
HC AUD EP SCRN AP W/BB STIMULI AA
|
Facility
|
OP
|
$988.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
900600650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$40.06 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Adventist Health Commercial |
$197.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$68.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$839.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$543.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$741.00
|
| Rate for Payer: Blue Shield of California Commercial |
$613.55
|
| Rate for Payer: Blue Shield of California EPN |
$579.96
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$642.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$839.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$839.80
|
| Rate for Payer: Dignity Health Senior |
$839.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$611.57
|
| Rate for Payer: Heritage Provider Network Senior |
$611.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$476.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.00
|
| Rate for Payer: Multiplan Commercial |
$741.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$839.80
|
| Rate for Payer: Vantage Medical Group Senior |
$839.80
|
|
|
HC AUDIOLOGIC EVAL PURE TONE 30M
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
905601900
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$59.19 |
| Max. Negotiated Rate |
$245.25 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$224.65
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.38
|
| Rate for Payer: Heritage Provider Network Senior |
$221.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
|
|
HC AUDIOLOGIC EVAL PURE TONE 30M
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
905601900
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$224.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$245.25
|
| Rate for Payer: Blue Shield of California Commercial |
$203.07
|
| Rate for Payer: Blue Shield of California EPN |
$191.95
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$212.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: Dignity Health Senior |
$277.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.41
|
| Rate for Payer: Heritage Provider Network Senior |
$202.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$157.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.75
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC AUG/ALTR COMM
|
Facility
|
IP
|
$227.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$170.25 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.95
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$153.68
|
| Rate for Payer: Heritage Provider Network Senior |
$153.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.75
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
|
|
HC AUG/ALTR COMM
|
Facility
|
OP
|
$227.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$121.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$155.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.25
|
| 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 |
$102.15
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$147.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.95
|
| Rate for Payer: Dignity Health Senior |
$192.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$140.51
|
| Rate for Payer: Heritage Provider Network Senior |
$140.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$109.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.75
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| 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 |
$192.95
|
| Rate for Payer: Vantage Medical Group Senior |
$192.95
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.25 |
| Max. Negotiated Rate |
$353.25 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$323.58
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$318.87
|
| Rate for Payer: Heritage Provider Network Senior |
$318.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.25 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$94.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$323.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cash Price |
$211.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$306.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: Dignity Health Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$250.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$318.87
|
| Rate for Payer: Heritage Provider Network Senior |
$318.87
|
| Rate for Payer: Humana Medicare |
$250.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$227.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$315.18
|
| Rate for Payer: Multiplan Commercial |
$353.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$171.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$157.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC AVULSION EA ADD'L NAIL PLATE
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
900501224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$49.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$160.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.95
|
| Rate for Payer: Dignity Health Senior |
$209.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$167.22
|
| Rate for Payer: Heritage Provider Network Senior |
$167.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$119.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.75
|
| Rate for Payer: Multiplan Commercial |
$185.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$89.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$82.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.95
|
| Rate for Payer: Vantage Medical Group Senior |
$209.95
|
|
