|
HC ABD PARACENTESIS W IMAG GUID
|
Facility
|
IP
|
$1,957.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
901249083
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$354.22 |
| Max. Negotiated Rate |
$1,467.75 |
| Rate for Payer: Adventist Health Commercial |
$391.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,260.31
|
| Rate for Payer: Cash Price |
$880.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,324.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,324.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$354.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.25
|
| Rate for Payer: Multiplan Commercial |
$1,467.75
|
|
|
HC ABD PARACENTESIS W IMAG GUID
|
Facility
|
OP
|
$1,957.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
901249083
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$354.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$391.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,209.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,193.77
|
| Rate for Payer: Blue Shield of California EPN |
$955.02
|
| Rate for Payer: Cash Price |
$880.65
|
| Rate for Payer: Cash Price |
$880.65
|
| Rate for Payer: Cash Price |
$880.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,272.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,211.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,211.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$933.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$354.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$1,467.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,283.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1,166.53
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$978.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$978.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ABD PARACENTESIS WO IMAGE GUID
|
Facility
|
OP
|
$2,727.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
906749081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$493.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,685.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$1,227.15
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,772.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,688.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,216.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,283.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1,283.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ABD PARACENTESIS WO IMAGE GUID
|
Facility
|
IP
|
$2,727.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
906749081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$493.59 |
| Max. Negotiated Rate |
$2,045.25 |
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,756.19
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$493.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
|
|
HC ABD PARACENTESIS WO IMAGE GUIDE
|
Facility
|
IP
|
$2,886.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901249082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$522.37 |
| Max. Negotiated Rate |
$2,164.50 |
| Rate for Payer: Adventist Health Commercial |
$577.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,858.58
|
| Rate for Payer: Cash Price |
$1,298.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,953.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.50
|
| Rate for Payer: Multiplan Commercial |
$2,164.50
|
|
|
HC ABD PARACENTESIS WO IMAGE GUIDE
|
Facility
|
OP
|
$2,886.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901249082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$522.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$577.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,783.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$1,298.70
|
| Rate for Payer: Cash Price |
$1,298.70
|
| Rate for Payer: Cash Price |
$1,298.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,875.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,786.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,216.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$522.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,164.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,283.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1,283.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
909081315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$398.38 |
| Max. Negotiated Rate |
$1,650.75 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,417.44
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,490.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,490.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$398.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.25
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
909081315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$398.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,360.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$990.45
|
| Rate for Payer: Cash Price |
$990.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,430.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,362.42
|
| Rate for Payer: Heritage Provider Network Senior |
$1,362.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,049.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$398.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$550.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,540.70
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| 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 |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.85
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
909081324
|
|
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: Aetna of CA Non-Gatekeeper |
$506.83
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.80
|
| Rate for Payer: Heritage Provider Network Senior |
$532.80
|
| Rate for Payer: Kaiser Foundation Hospitals 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, 2ND ORDR CA
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
909081324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.45 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$486.37
|
| 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 |
$6,245.00
|
| 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 |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$375.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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
|
$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: Aetna of CA Non-Gatekeeper |
$506.83
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$532.80
|
| Rate for Payer: Heritage Provider Network Senior |
$532.80
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$787.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.45 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$486.37
|
| 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 |
$6,245.00
|
| 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 |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$375.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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, ADDL 2ND/3R
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$130.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$401.70
|
| 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 |
$3,672.00
|
| 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 |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$310.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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: Aetna of CA Non-Gatekeeper |
$418.60
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$440.05
|
| Rate for Payer: Heritage Provider Network Senior |
$440.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.50
|
| Rate for Payer: Multiplan Commercial |
$487.50
|
|
|
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: Aetna of CA Non-Gatekeeper |
$2,814.28
|
| Rate for Payer: Cash Price |
$1,966.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,958.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,958.49
|
| Rate for Payer: Kaiser Foundation Hospitals 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 EA ADD LEVEL
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$790.97 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,700.66
|
| 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 |
$3,672.00
|
| 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 |
$1,966.50
|
| Rate for Payer: Cash Price |
$1,966.50
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$2,084.49
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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: Aetna of CA Non-Gatekeeper |
$4,631.65
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,868.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,868.98
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$1,301.75 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,444.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,674.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,315.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,511.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,451.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,089.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,771.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,301.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,888.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,762.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,762.68
|
| 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 |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
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: Aetna of CA Non-Gatekeeper |
$16,114.17
|
| Rate for Payer: Cash Price |
$11,259.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,939.89
|
| Rate for Payer: Heritage Provider Network Senior |
$16,939.89
|
| Rate for Payer: Kaiser Foundation Hospitals 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,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 |
$4,528.98 |
| Max. Negotiated Rate |
$18,766.50 |
| Rate for Payer: Adventist Health Commercial |
$5,004.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$15,463.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,775.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| 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 |
$11,259.90
|
| Rate for Payer: Cash Price |
$11,259.90
|
| Rate for Payer: Cash Price |
$11,259.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,264.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,663.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,553.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,775.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,775.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,488.62
|
| Rate for Payer: Heritage Provider Network Senior |
$9,563.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,775.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,773.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,528.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,941.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,255.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,419.25
|
| Rate for Payer: Multiplan Commercial |
$18,766.50
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,553.12
|
| Rate for Payer: TriValley Medical Group Senior |
$8,553.12
|
| 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 |
$11,663.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,553.12
|
| Rate for Payer: Vantage Medical Group Senior |
$7,775.56
|
|
|
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: Aetna of CA Non-Gatekeeper |
$598.92
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$930.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$168.33 |
| Max. Negotiated Rate |
$15,309.00 |
| Rate for Payer: Adventist Health Commercial |
$186.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$574.74
|
| 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 |
$15,309.00
|
| 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 |
$418.50
|
| Rate for Payer: Cash Price |
$418.50
|
| 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 Medicare Advantage |
$790.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$575.67
|
| Rate for Payer: Heritage Provider Network Senior |
$575.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$443.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 SECONDARY ARRHYTHMIA
|
Facility
|
OP
|
$14,000.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
906811447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$15,309.00 |
| Rate for Payer: Adventist Health Commercial |
$2,800.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,652.00
|
| 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 |
$15,309.00
|
| 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 |
$6,300.00
|
| Rate for Payer: Cash Price |
$6,300.00
|
| 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 Medicare Advantage |
$11,900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,260.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,666.00
|
| Rate for Payer: Heritage Provider Network Senior |
$8,666.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,678.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
$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: Aetna of CA Non-Gatekeeper |
$9,016.00
|
| Rate for Payer: Cash Price |
$6,300.00
|
| Rate for Payer: Cash Price |
$6,300.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$727.08
|
| Rate for Payer: Cash Price |
$508.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$764.33
|
| Rate for Payer: Heritage Provider Network Senior |
$764.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.25
|
| Rate for Payer: Multiplan Commercial |
$846.75
|
|
