|
HC ELECT STIM UNATTEND WOUND CARE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
905103508
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC ELECT STIM UNATTEND WOUND CARE COMM MCARE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900419078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC ELECT STIM UNATTEND WOUND CARE COMM MCARE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900419078
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: Dignity Health Senior |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$23.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$81.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.25
|
| Rate for Payer: Dignity Health Senior |
$106.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.38
|
| Rate for Payer: Heritage Provider Network Senior |
$77.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.25
|
| Rate for Payer: Vantage Medical Group Senior |
$106.25
|
|
|
HC ELECT STIM UNATTEND WOUND CARE MCAL
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT G0282
|
| Hospital Charge Code |
900400044
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$85.88
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.62
|
| Rate for Payer: Heritage Provider Network Senior |
$84.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.25
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
OP
|
$8,326.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$8,576.00 |
| Rate for Payer: Adventist Health Commercial |
$1,665.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,971.01
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,719.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,411.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,411.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,636.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,636.70
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,013.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,507.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,081.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$6,244.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,023.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,781.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC ELEV DEPRESSED SKULL FX, SIMPL
|
Facility
|
IP
|
$8,326.00
|
|
|
Service Code
|
CPT 62000
|
| Hospital Charge Code |
900501690
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,507.01 |
| Max. Negotiated Rate |
$6,244.50 |
| Rate for Payer: Adventist Health Commercial |
$1,665.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,719.96
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,636.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,636.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,507.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,081.50
|
| Rate for Payer: Multiplan Commercial |
$6,244.50
|
|
|
HC EMBOLIC ONYX
|
Facility
|
IP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,880.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,122.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,760.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,240.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,062.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,062.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,000.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,000.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,187.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,004.60
|
|
|
HC EMBOLIC ONYX
|
Facility
|
OP
|
$6,000.00
|
|
| Hospital Charge Code |
909081019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,200.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,880.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,122.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,300.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,500.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,726.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,522.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cash Price |
$2,700.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,760.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,100.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,100.00
|
| Rate for Payer: Dignity Health Senior |
$5,100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,840.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,778.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,778.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,000.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,000.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.00
|
| Rate for Payer: Multiplan Commercial |
$4,500.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,187.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,004.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,100.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,100.00
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
|
IP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$171.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$242.37
|
| Rate for Payer: Heritage Provider Network Senior |
$242.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.50
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$130.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$119.61
|
|
|
HC EMBOLIZATION COILS .018
|
Facility
|
OP
|
$358.00
|
|
| Hospital Charge Code |
909081257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$71.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$171.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$245.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$304.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$268.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$222.32
|
| Rate for Payer: Blue Shield of California EPN |
$210.15
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$164.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$304.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$304.30
|
| Rate for Payer: Dignity Health Senior |
$304.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Senior |
$165.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.50
|
| Rate for Payer: Multiplan Commercial |
$268.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$130.53
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$119.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$304.30
|
| Rate for Payer: Vantage Medical Group Senior |
$304.30
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
IP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,525.00 |
| Max. Negotiated Rate |
$18,750.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,175.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,925.00
|
| Rate for Payer: Heritage Provider Network Senior |
$16,925.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,525.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
|
|
HC EMBOLIZATION DEVICE PIPELINE
|
Facility
|
OP
|
$25,000.00
|
|
| Hospital Charge Code |
909020126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,525.00 |
| Max. Negotiated Rate |
$21,250.00 |
| Rate for Payer: Adventist Health Commercial |
$5,000.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13,362.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17,175.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,750.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15,525.00
|
| Rate for Payer: Blue Shield of California EPN |
$14,675.00
|
| Rate for Payer: Cash Price |
$11,250.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$16,250.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,250.00
|
| Rate for Payer: Dignity Health Senior |
$21,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,250.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,475.00
|
| Rate for Payer: Heritage Provider Network Senior |
$15,475.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,050.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,525.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,250.00
|
| Rate for Payer: Multiplan Commercial |
$18,750.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,250.00
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
IP
|
$53,234.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,635.35 |
| Max. Negotiated Rate |
$39,925.50 |
| Rate for Payer: Adventist Health Commercial |
$10,646.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,571.76
|
| Rate for Payer: Cash Price |
$23,955.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,039.42
|
| Rate for Payer: Heritage Provider Network Senior |
$36,039.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,635.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,308.50
|
| Rate for Payer: Multiplan Commercial |
$39,925.50
|
|
|
HC EMBOLIZATION, EXTRACRANIAL
|
Facility
|
OP
|
$53,234.00
|
|
|
Service Code
|
CPT 61626
|
| Hospital Charge Code |
909081338
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.41 |
| Max. Negotiated Rate |
$39,925.50 |
| Rate for Payer: Adventist Health Commercial |
$10,646.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$36,571.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,500.11
|
| Rate for Payer: Blue Shield of California EPN |
$9,024.37
|
| Rate for Payer: Cash Price |
$23,955.30
|
| Rate for Payer: Cash Price |
$23,955.30
|
| Rate for Payer: Cash Price |
$23,955.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$34,602.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,940.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,951.85
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,635.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,308.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$39,925.50
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC EMBOLIZATION FOAM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$217.35
|
| Rate for Payer: Blue Shield of California EPN |
$205.45
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Senior |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.05
|
| Rate for Payer: Heritage Provider Network Senior |
$162.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$127.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC EMBOLIZATION FOAM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
909081259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$168.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$240.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$236.95
|
| Rate for Payer: Heritage Provider Network Senior |
$236.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$127.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$116.94
|
|
|
HC EMBOLIZATION LCBEADS
|
Facility
|
IP
|
$4,397.50
|
|
| Hospital Charge Code |
909020052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$795.95 |
| Max. Negotiated Rate |
$3,298.12 |
| Rate for Payer: Adventist Health Commercial |
$879.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,021.08
|
| Rate for Payer: Cash Price |
$1,978.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,977.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,977.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$795.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.38
|
| Rate for Payer: Multiplan Commercial |
$3,298.12
|
|
|
HC EMBOLIZATION LCBEADS
|
Facility
|
OP
|
$4,397.50
|
|
| Hospital Charge Code |
909020052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$795.95 |
| Max. Negotiated Rate |
$3,737.88 |
| Rate for Payer: Adventist Health Commercial |
$879.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,350.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,021.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,418.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,298.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,730.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,581.33
|
| Rate for Payer: Cash Price |
$1,978.88
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,858.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,737.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,737.88
|
| Rate for Payer: Dignity Health Senior |
$3,737.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,858.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,722.05
|
| Rate for Payer: Heritage Provider Network Senior |
$2,722.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,119.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$795.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,099.38
|
| Rate for Payer: Multiplan Commercial |
$3,298.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,737.88
|
| Rate for Payer: Vantage Medical Group Senior |
$3,737.88
|
|
|
HC EMBOLIZATION PARTICLE
|
Facility
|
OP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$538.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$771.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$954.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$617.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$841.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$697.01
|
| Rate for Payer: Blue Shield of California EPN |
$658.85
|
| Rate for Payer: Cash Price |
$505.08
|
| Rate for Payer: Cash Price |
$505.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$954.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$954.04
|
| Rate for Payer: Dignity Health Senior |
$954.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$519.67
|
| Rate for Payer: Heritage Provider Network Senior |
$519.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$561.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$561.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.60
|
| Rate for Payer: Multiplan Commercial |
$841.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$409.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$374.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$954.04
|
| Rate for Payer: Vantage Medical Group Senior |
$954.04
|
|
|
HC EMBOLIZATION PARTICLE
|
Facility
|
IP
|
$1,122.40
|
|
| Hospital Charge Code |
909081256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$224.48
|
| Rate for Payer: Aetna of CA Gatekeeper |
$538.75
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$771.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$505.08
|
| Rate for Payer: Cash Price |
$505.08
|
| Rate for Payer: Cigna of CA HMO/PPO |
$516.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$759.86
|
| Rate for Payer: Heritage Provider Network Senior |
$759.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$561.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$561.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$561.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.60
|
| Rate for Payer: Multiplan Commercial |
$841.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$409.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$374.99
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
OP
|
$18,064.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,302.13 |
| Max. Negotiated Rate |
$17,002.00 |
| Rate for Payer: Adventist Health Commercial |
$3,612.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,420.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,409.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,354.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,935.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,548.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$8,128.80
|
| Rate for Payer: Cash Price |
$8,128.80
|
| Rate for Payer: Cash Price |
$8,128.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,741.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,354.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,354.40
|
| Rate for Payer: Dignity Health Senior |
$15,354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,838.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,181.62
|
| Rate for Payer: Heritage Provider Network Senior |
$11,181.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,302.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,706.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,269.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,516.00
|
| Rate for Payer: Multiplan Commercial |
$13,548.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,354.40
|
| Rate for Payer: Vantage Medical Group Senior |
$15,354.40
|
|
|
HC EMBOLIZ, INTRACRAN/SP.CRD.
|
Facility
|
IP
|
$18,064.00
|
|
|
Service Code
|
CPT 61624
|
| Hospital Charge Code |
909081337
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,269.58 |
| Max. Negotiated Rate |
$13,548.00 |
| Rate for Payer: Adventist Health Commercial |
$3,612.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,409.97
|
| Rate for Payer: Cash Price |
$8,128.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,229.33
|
| Rate for Payer: Heritage Provider Network Senior |
$12,229.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,269.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,516.00
|
| Rate for Payer: Multiplan Commercial |
$13,548.00
|
|
|
HC ENDLMNL BX RNL PLVS AND OR URE
|
Facility
|
IP
|
$13,955.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
909050606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,525.86 |
| Max. Negotiated Rate |
$10,466.25 |
| Rate for Payer: Adventist Health Commercial |
$2,791.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,587.08
|
| Rate for Payer: Cash Price |
$6,279.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,447.54
|
| Rate for Payer: Heritage Provider Network Senior |
$9,447.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,525.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,488.75
|
| Rate for Payer: Multiplan Commercial |
$10,466.25
|
|
|
HC ENDLMNL BX RNL PLVS AND OR URE
|
Facility
|
OP
|
$13,955.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
909050606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$749.80 |
| Max. Negotiated Rate |
$11,861.75 |
| Rate for Payer: Adventist Health Commercial |
$2,791.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,587.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,861.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,675.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,466.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$6,279.75
|
| Rate for Payer: Cash Price |
$6,279.75
|
| Rate for Payer: Cash Price |
$6,279.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,070.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,861.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,861.75
|
| Rate for Payer: Dignity Health Senior |
$11,861.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,638.14
|
| Rate for Payer: Heritage Provider Network Senior |
$8,638.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$749.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,726.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,525.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,488.75
|
| Rate for Payer: Multiplan Commercial |
$10,466.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,861.75
|
| Rate for Payer: Vantage Medical Group Senior |
$11,861.75
|
|
