|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.75 |
| Max. Negotiated Rate |
$728.25 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$625.32
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.37
|
| Rate for Payer: Heritage Provider Network Senior |
$657.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.75
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
|
|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$600.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$461.23
|
| Rate for Payer: Blue Shield of California EPN |
$367.04
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$631.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.37
|
| Rate for Payer: Heritage Provider Network Senior |
$657.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$463.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$582.60
|
| Rate for Payer: TriValley Medical Group Senior |
$582.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$600.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| 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 |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$631.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$601.05
|
| Rate for Payer: Heritage Provider Network Senior |
$485.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$750.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$434.27
|
| Rate for Payer: TriValley Medical Group Senior |
$434.27
|
| 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 |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC ASPIRATION/INJ GANGLION CYSTS
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
909020036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.75 |
| Max. Negotiated Rate |
$728.25 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$625.32
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.37
|
| Rate for Payer: Heritage Provider Network Senior |
$657.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.75
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
|
IP
|
$2,982.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$539.74 |
| Max. Negotiated Rate |
$2,236.50 |
| Rate for Payer: Adventist Health Commercial |
$596.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,920.41
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,018.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2,018.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$539.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$745.50
|
| Rate for Payer: Multiplan Commercial |
$2,236.50
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
|
OP
|
$2,982.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$539.74 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$596.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,842.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,416.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,127.20
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,938.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,938.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,018.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2,018.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,422.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$539.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$745.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,236.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,789.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1,789.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
|
IP
|
$2,982.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$539.74 |
| Max. Negotiated Rate |
$2,236.50 |
| Rate for Payer: Adventist Health Commercial |
$596.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,920.41
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,018.81
|
| Rate for Payer: Heritage Provider Network Senior |
$2,018.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$539.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$745.50
|
| Rate for Payer: Multiplan Commercial |
$2,236.50
|
|
|
HC ASPIR INJECT THYROID CYST
|
Facility
|
OP
|
$2,982.00
|
|
|
Service Code
|
CPT 60300
|
| Hospital Charge Code |
909020010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$539.74 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$596.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,842.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| 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 |
$1,341.90
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,938.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,789.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,845.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$539.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$745.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,236.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$449.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| 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 |
$327.15
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$472.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.01
|
| Rate for Payer: Heritage Provider Network Senior |
$485.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$750.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$434.27
|
| Rate for Payer: TriValley Medical Group Senior |
$434.27
|
| 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 |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$545.25 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$468.19
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$492.18
|
| Rate for Payer: Heritage Provider Network Senior |
$492.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.75
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$449.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$345.32
|
| Rate for Payer: Blue Shield of California EPN |
$274.81
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$472.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$492.18
|
| Rate for Payer: Heritage Provider Network Senior |
$492.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$346.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$436.20
|
| Rate for Payer: TriValley Medical Group Senior |
$436.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC ASPIR/INJ MAJOR JOINT/BURSA
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
900501055
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.59 |
| Max. Negotiated Rate |
$545.25 |
| Rate for Payer: Adventist Health Commercial |
$145.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$468.19
|
| Rate for Payer: Cash Price |
$327.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$492.18
|
| Rate for Payer: Heritage Provider Network Senior |
$492.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.75
|
| Rate for Payer: Multiplan Commercial |
$545.25
|
|
|
HC ASSAY OF INTERLEUKIN 6 (IL 6)
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 83529
|
| Hospital Charge Code |
900915379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$99.48 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.15
|
| Rate for Payer: Blue Shield of California Commercial |
$99.48
|
| Rate for Payer: Blue Shield of California EPN |
$79.79
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.98
|
| Rate for Payer: EPIC Health Plan Medicare |
$17.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$17.27
|
| Rate for Payer: TriValley Medical Group Senior |
$17.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$18.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC ASSAY OF INTERLEUKIN 6 (IL 6)
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 83529
|
| Hospital Charge Code |
900915379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14.17
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.89
|
| Rate for Payer: Heritage Provider Network Senior |
$14.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
|
|
HC ASSESS APHASIA W/RPT 1HR MCAL
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
907000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$627.75 |
| Rate for Payer: Adventist Health Commercial |
$167.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$539.03
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$566.65
|
| Rate for Payer: Heritage Provider Network Senior |
$566.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$627.75
|
|
|
HC ASSESS APHASIA W/RPT 1HR MCAL
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
907000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$711.45 |
| Rate for Payer: Adventist Health Commercial |
$343.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$544.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$711.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$711.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.10
|
| Rate for Payer: Heritage Provider Network Senior |
$518.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$399.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$585.90
|
| Rate for Payer: Multiplan Commercial |
$627.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.45
|
| Rate for Payer: Vantage Medical Group Senior |
$711.45
|
|
|
HC ASSESS APHASIA W/RPT 60 MIN
|
Facility
|
OP
|
$837.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
905601803
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$711.45 |
| Rate for Payer: Adventist Health Commercial |
$343.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$711.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$460.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.00
|
| Rate for Payer: Blue Shield of California Commercial |
$354.00
|
| Rate for Payer: Blue Shield of California EPN |
$284.00
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$544.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$711.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$711.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$544.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$518.10
|
| Rate for Payer: Heritage Provider Network Senior |
$518.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$399.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$585.90
|
| Rate for Payer: Multiplan Commercial |
$627.75
|
| 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 |
$261.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$711.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.45
|
| Rate for Payer: Vantage Medical Group Senior |
$711.45
|
|
|
HC ASSESS APHASIA W/RPT 60 MIN
|
Facility
|
IP
|
$837.00
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
905601803
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$627.75 |
| Rate for Payer: Adventist Health Commercial |
$167.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$539.03
|
| Rate for Payer: Cash Price |
$376.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$566.65
|
| Rate for Payer: Heritage Provider Network Senior |
$566.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.25
|
| Rate for Payer: Multiplan Commercial |
$627.75
|
|
|
HC AST
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC AST
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Blue Shield of California Commercial |
$41.59
|
| Rate for Payer: Blue Shield of California Commercial |
$41.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.36
|
| Rate for Payer: Blue Shield of California EPN |
$33.36
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC AST INDIVIDUAL
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.09
|
| Rate for Payer: Blue Shield of California Commercial |
$41.59
|
| Rate for Payer: Blue Shield of California Commercial |
$41.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.36
|
| Rate for Payer: Blue Shield of California EPN |
$33.36
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$32.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$30.95
|
| Rate for Payer: Heritage Provider Network Senior |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$46.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: TriValley Medical Group Senior |
$5.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC AST INDIVIDUAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 84450
|
| Hospital Charge Code |
900910232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.35
|
| Rate for Payer: Heritage Provider Network Senior |
$66.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC ATHERECTOMY AORTA
|
Facility
|
OP
|
$27,456.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,969.54 |
| Max. Negotiated Rate |
$23,337.60 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,967.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,100.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,592.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,733.49
|
| 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 |
$12,355.20
|
| Rate for Payer: Cash Price |
$12,355.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,846.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,337.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,473.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,995.26
|
| Rate for Payer: Heritage Provider Network Senior |
$16,995.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,096.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,969.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,864.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,219.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,728.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13,728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Senior |
$23,337.60
|
|
|
HC ATHERECTOMY AORTA
|
Facility
|
IP
|
$27,456.00
|
|
| Hospital Charge Code |
909080029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,969.54 |
| Max. Negotiated Rate |
$20,592.00 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,681.66
|
| Rate for Payer: Cash Price |
$12,355.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,587.71
|
| Rate for Payer: Heritage Provider Network Senior |
$18,587.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,969.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,864.00
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
|
|
HC ATHERECTOMY BRACH/CEPH BRANCH
|
Facility
|
OP
|
$27,456.00
|
|
| Hospital Charge Code |
909080031
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,969.54 |
| Max. Negotiated Rate |
$23,337.60 |
| Rate for Payer: Adventist Health Commercial |
$5,491.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$16,967.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,100.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,592.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,733.49
|
| 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 |
$12,355.20
|
| Rate for Payer: Cash Price |
$12,355.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,846.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,337.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,473.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,995.26
|
| Rate for Payer: Heritage Provider Network Senior |
$16,995.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,096.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,969.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,864.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,219.20
|
| Rate for Payer: Multiplan Commercial |
$20,592.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,728.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$13,728.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,337.60
|
| Rate for Payer: Vantage Medical Group Senior |
$23,337.60
|
|
