|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$540.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$432.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$511.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$668.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$668.95
|
| Rate for Payer: Dignity Health Senior |
$668.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$487.15
|
| Rate for Payer: Heritage Provider Network Senior |
$487.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$469.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$375.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$550.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$550.90
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$668.95
|
| Rate for Payer: Vantage Medical Group Senior |
$668.95
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
906820181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.47 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$420.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$517.90
|
| Rate for Payer: Heritage Provider Network Senior |
$517.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$573.75
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.45 |
| Max. Negotiated Rate |
$590.25 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.80
|
| Rate for Payer: Heritage Provider Network Senior |
$532.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.75
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
906820181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$525.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$650.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$420.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$573.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$420.75
|
| Rate for Payer: Cash Price |
$420.75
|
| Rate for Payer: Cash Price |
$420.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$497.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$650.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$650.25
|
| Rate for Payer: Dignity Health Senior |
$650.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$473.54
|
| Rate for Payer: Heritage Provider Network Senior |
$473.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$469.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$364.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$535.50
|
| Rate for Payer: Multiplan Commercial |
$573.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$650.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$650.25
|
| Rate for Payer: Vantage Medical Group Senior |
$650.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
906820182
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.39 |
| Max. Negotiated Rate |
$474.00 |
| Rate for Payer: Adventist Health Commercial |
$126.40
|
| Rate for Payer: Cash Price |
$347.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$427.86
|
| Rate for Payer: Heritage Provider Network Senior |
$427.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.00
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
906820182
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$126.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$434.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$537.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$347.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$474.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$347.60
|
| Rate for Payer: Cash Price |
$347.60
|
| Rate for Payer: Cash Price |
$347.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$410.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$537.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$537.20
|
| Rate for Payer: Dignity Health Senior |
$537.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$391.21
|
| Rate for Payer: Heritage Provider Network Senior |
$391.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$301.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$442.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$442.40
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$537.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$537.20
|
| Rate for Payer: Vantage Medical Group Senior |
$537.20
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Adventist Health Commercial |
$130.00
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$440.05
|
| Rate for Payer: Heritage Provider Network Senior |
$440.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.50
|
| Rate for Payer: Multiplan Commercial |
$487.50
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$130.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$446.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$552.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$487.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$422.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$552.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$552.50
|
| Rate for Payer: Dignity Health Senior |
$552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$402.35
|
| Rate for Payer: Heritage Provider Network Senior |
$402.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$310.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$455.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$455.00
|
| Rate for Payer: Multiplan Commercial |
$487.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$552.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$552.50
|
| Rate for Payer: Vantage Medical Group Senior |
$552.50
|
|
|
HC ABLAT CERV/THORAC EA ADD LEVEL
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,002.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,403.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,277.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,840.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,714.50
|
| Rate for Payer: Dignity Health Senior |
$3,714.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,705.03
|
| Rate for Payer: Heritage Provider Network Senior |
$2,705.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,084.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$790.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,092.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,059.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,059.00
|
| Rate for Payer: Multiplan Commercial |
$3,277.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,714.50
|
|
|
HC ABLAT CERV/THORAC EA ADD LEVEL
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$790.97 |
| Max. Negotiated Rate |
$3,277.50 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,958.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,958.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$790.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,092.50
|
| Rate for Payer: Multiplan Commercial |
$3,277.50
|
|
|
HC ABLAT CERV/THORAC NERVE SNGL L
|
Facility
|
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909000264
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,868.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,868.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
|
|
HC ABLAT CERV/THORAC NERVE SNGL L
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909000264
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,940.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,674.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Senior |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,315.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,481.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,451.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,051.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$323.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,714.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,853.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,126.30
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,729.31
|
| Rate for Payer: TriValley Medical Group Senior |
$2,729.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC ABLATION,1 OR MORE LIVER TUM
|
Facility
|
OP
|
$25,022.00
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
909000246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$18,766.50 |
| Rate for Payer: Adventist Health Commercial |
$5,004.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,190.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,413.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$13,762.10
|
| Rate for Payer: Cash Price |
$13,762.10
|
| Rate for Payer: Cash Price |
$13,762.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,264.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,154.45
|
| Rate for Payer: Dignity Health Senior |
$7,413.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,413.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,488.62
|
| Rate for Payer: Heritage Provider Network Senior |
$9,118.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$897.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,413.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14,084.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,528.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,525.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,255.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,340.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,340.56
|
| Rate for Payer: Multiplan Commercial |
$18,766.50
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,154.45
|
| Rate for Payer: TriValley Medical Group Senior |
$8,154.45
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,413.14
|
|
|
HC ABLATION,1 OR MORE LIVER TUM
|
Facility
|
IP
|
$25,022.00
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
909000246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,528.98 |
| Max. Negotiated Rate |
$18,766.50 |
| Rate for Payer: Adventist Health Commercial |
$5,004.40
|
| Rate for Payer: Cash Price |
$13,762.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,939.89
|
| Rate for Payer: Heritage Provider Network Senior |
$16,939.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,528.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,255.50
|
| Rate for Payer: Multiplan Commercial |
$18,766.50
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
IP
|
$1,094.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906820252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$198.01 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.50
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$638.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: Dignity Health Senior |
$790.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$604.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$575.67
|
| Rate for Payer: Heritage Provider Network Senior |
$575.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$534.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$443.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$651.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$168.33 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.50
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
OP
|
$1,094.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906820252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$218.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$751.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$601.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$820.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cash Price |
$601.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$929.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$929.90
|
| Rate for Payer: Dignity Health Senior |
$929.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$711.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$677.19
|
| Rate for Payer: Heritage Provider Network Senior |
$677.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$534.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$521.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$765.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$765.80
|
| Rate for Payer: Multiplan Commercial |
$820.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$929.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$929.90
|
| Rate for Payer: Vantage Medical Group Senior |
$929.90
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
IP
|
$14,000.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,534.00 |
| Max. Negotiated Rate |
$10,500.00 |
| Rate for Payer: Adventist Health Commercial |
$2,800.00
|
| Rate for Payer: Cash Price |
$7,700.00
|
| Rate for Payer: Cash Price |
$7,700.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,534.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$10,500.00
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
OP
|
$15,920.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906820250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$3,184.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,937.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,532.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,756.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,940.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$8,756.00
|
| Rate for Payer: Cash Price |
$8,756.00
|
| Rate for Payer: Cash Price |
$8,756.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,532.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,532.00
|
| Rate for Payer: Dignity Health Senior |
$13,532.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,348.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,854.48
|
| Rate for Payer: Heritage Provider Network Senior |
$9,854.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$534.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,593.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,881.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,980.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,144.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,144.00
|
| Rate for Payer: Multiplan Commercial |
$11,940.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,532.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,532.00
|
| Rate for Payer: Vantage Medical Group Senior |
$13,532.00
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
OP
|
$14,000.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,720.00 |
| Rate for Payer: Adventist Health Commercial |
$2,800.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,618.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,900.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,700.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$7,700.00
|
| Rate for Payer: Cash Price |
$7,700.00
|
| Rate for Payer: Cash Price |
$7,700.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,900.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,900.00
|
| Rate for Payer: Dignity Health Senior |
$11,900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,100.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,666.00
|
| Rate for Payer: Heritage Provider Network Senior |
$8,666.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$534.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,678.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,534.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,500.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,800.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,800.00
|
| Rate for Payer: Multiplan Commercial |
$10,500.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,900.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,900.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11,900.00
|
|
|
HC ABLATION SECONDARY ARRHYTHMIA
|
Facility
|
IP
|
$15,920.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906820250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,881.52 |
| Max. Negotiated Rate |
$11,940.00 |
| Rate for Payer: Adventist Health Commercial |
$3,184.00
|
| Rate for Payer: Cash Price |
$8,756.00
|
| Rate for Payer: Cash Price |
$8,756.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,881.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,980.00
|
| Rate for Payer: Multiplan Commercial |
$11,940.00
|
|
|
HC ABLATION SPINE OTHER
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$225.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$775.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$620.95
|
| Rate for Payer: Cash Price |
$620.95
|
| Rate for Payer: Cash Price |
$620.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$733.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Senior |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$698.85
|
| Rate for Payer: Heritage Provider Network Senior |
$374.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$579.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.04
|
| Rate for Payer: Multiplan Commercial |
$846.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$335.27
|
| Rate for Payer: TriValley Medical Group Senior |
$335.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC ABLATION SPINE OTHER
|
Facility
|
IP
|
$1,129.00
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
909022899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.35 |
| Max. Negotiated Rate |
$846.75 |
| Rate for Payer: Adventist Health Commercial |
$225.80
|
| Rate for Payer: Cash Price |
$620.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$764.33
|
| Rate for Payer: Heritage Provider Network Senior |
$764.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.25
|
| Rate for Payer: Multiplan Commercial |
$846.75
|
|
|
HC ABLAT LUM/SAC NERVE SNGL LEVEL
|
Facility
|
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909000262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,868.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,868.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
|
