|
HC ENDO SM INT W/SNARE
|
Facility
|
IP
|
$3,685.00
|
|
|
Service Code
|
CPT 44364
|
| Hospital Charge Code |
906744364
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$666.98 |
| Max. Negotiated Rate |
$2,763.75 |
| Rate for Payer: Adventist Health Commercial |
$737.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,531.60
|
| Rate for Payer: Cash Price |
$1,658.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,494.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,494.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$666.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.25
|
| Rate for Payer: Multiplan Commercial |
$2,763.75
|
|
|
HC ENDO SM INT W/SNARE
|
Facility
|
OP
|
$2,622.00
|
|
|
Service Code
|
CPT 44364
|
| Hospital Charge Code |
906744364
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$316.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$524.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,801.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,179.90
|
| Rate for Payer: Cash Price |
$1,179.90
|
| Rate for Payer: Cash Price |
$1,179.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,704.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,623.02
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$655.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$1,966.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ENDO SM INT W STENT PLCMNT
|
Facility
|
IP
|
$7,036.00
|
|
|
Service Code
|
CPT 44370
|
| Hospital Charge Code |
906744370
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,273.52 |
| Max. Negotiated Rate |
$5,277.00 |
| Rate for Payer: Adventist Health Commercial |
$1,407.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,833.73
|
| Rate for Payer: Cash Price |
$3,166.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,763.37
|
| Rate for Payer: Heritage Provider Network Senior |
$4,763.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,273.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.00
|
| Rate for Payer: Multiplan Commercial |
$5,277.00
|
|
|
HC ENDO SM INT W STENT PLCMNT
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 44370
|
| Hospital Charge Code |
906744370
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$307.82 |
| Max. Negotiated Rate |
$14,131.19 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,940.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| 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 |
$10,681.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: Dignity Health Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,120.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,451.85
|
| Rate for Payer: Heritage Provider Network Senior |
$8,758.62
|
| Rate for Payer: Humana Medicare |
$7,120.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,529.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,402.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,972.25
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
IP
|
$2,358.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$426.80 |
| Max. Negotiated Rate |
$1,768.50 |
| Rate for Payer: Adventist Health Commercial |
$471.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,619.95
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,596.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,596.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.50
|
| Rate for Payer: Multiplan Commercial |
$1,768.50
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
OP
|
$2,358.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$92.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$471.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,619.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$1,061.10
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,532.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: Dignity Health Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,459.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,459.60
|
| Rate for Payer: Humana Medicare |
$305.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$579.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$1,768.50
|
| 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 |
$358.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$304.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
OP
|
$2,358.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$471.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,619.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,532.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: Dignity Health Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,596.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,596.37
|
| Rate for Payer: Humana Medicare |
$305.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,136.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$1,768.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$856.19
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$787.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC ENDOTRACHEAL INTUBATION
|
Facility
|
IP
|
$2,358.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
900800115
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$426.80 |
| Max. Negotiated Rate |
$1,768.50 |
| Rate for Payer: Adventist Health Commercial |
$471.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,619.95
|
| Rate for Payer: Cash Price |
$1,061.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,596.37
|
| Rate for Payer: Heritage Provider Network Senior |
$1,596.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.50
|
| Rate for Payer: Multiplan Commercial |
$1,768.50
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
IP
|
$33,470.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6,058.07 |
| Max. Negotiated Rate |
$25,102.50 |
| Rate for Payer: Adventist Health Commercial |
$6,694.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,993.89
|
| Rate for Payer: Cash Price |
$15,061.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22,659.19
|
| Rate for Payer: Heritage Provider Network Senior |
$22,659.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,058.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,367.50
|
| Rate for Payer: Multiplan Commercial |
$25,102.50
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
OP
|
$33,470.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$6,694.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,245.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$22,993.89
|
| 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 |
$20,784.87
|
| Rate for Payer: Blue Shield of California EPN |
$19,646.89
|
| Rate for Payer: Cash Price |
$15,061.50
|
| Rate for Payer: Cash Price |
$15,061.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$21,755.50
|
| 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 |
$21,755.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,717.93
|
| Rate for Payer: Heritage Provider Network Senior |
$20,717.93
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$93.60
|
| 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 |
$6,058.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,367.50
|
| 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 |
$25,102.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$13,745.22
|
| Rate for Payer: TriValley Medical Group Senior |
$13,745.22
|
| 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 ENOVENOUS ABLATION THERAPY
|
Facility
|
IP
|
$20,992.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,799.55 |
| Max. Negotiated Rate |
$15,744.00 |
| Rate for Payer: Adventist Health Commercial |
$4,198.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,421.50
|
| Rate for Payer: Cash Price |
$9,446.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,211.58
|
| Rate for Payer: Heritage Provider Network Senior |
$14,211.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,799.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,248.00
|
| Rate for Payer: Multiplan Commercial |
$15,744.00
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
OP
|
$20,992.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,102.89 |
| Max. Negotiated Rate |
$15,744.00 |
| Rate for Payer: Adventist Health Commercial |
$4,198.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,421.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$9,446.40
|
| Rate for Payer: Cash Price |
$9,446.40
|
| Rate for Payer: Cash Price |
$9,446.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,644.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,994.05
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,102.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,799.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,248.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$15,744.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.69 |
| Max. Negotiated Rate |
$786.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.98
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$709.50
|
| Rate for Payer: Heritage Provider Network Senior |
$709.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.66 |
| Max. Negotiated Rate |
$786.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$315.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.16
|
| Rate for Payer: Blue Shield of California Commercial |
$266.69
|
| Rate for Payer: Blue Shield of California EPN |
$151.66
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$681.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$681.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.71
|
| Rate for Payer: Heritage Provider Network Senior |
$648.71
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$567.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$227.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.28 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$69.39
|
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$68.38
|
| Rate for Payer: Heritage Provider Network Senior |
$68.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.25
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$21.41 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7.37
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Blue Shield of California Commercial |
$19.84
|
| Rate for Payer: Blue Shield of California EPN |
$15.51
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.19
|
| Rate for Payer: Heritage Provider Network Senior |
$6.19
|
| Rate for Payer: Humana Medicare |
$2.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.20
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2.54
|
| Rate for Payer: TriValley Medical Group Senior |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Adventist Health Commercial |
$32.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$110.61
|
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.00
|
| Rate for Payer: Heritage Provider Network Senior |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.25
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$13.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.73
|
| Rate for Payer: Blue Shield of California Commercial |
$37.12
|
| Rate for Payer: Blue Shield of California EPN |
$29.02
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.37
|
| Rate for Payer: Dignity Health Senior |
$5.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Humana Medicare |
$5.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.79
|
| Rate for Payer: TriValley Medical Group Senior |
$5.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.25
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
OP
|
$1,822.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$364.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,251.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,184.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: Dignity Health Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,278.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,233.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,233.49
|
| Rate for Payer: Humana Medicare |
$2,278.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$878.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,688.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,870.90
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$661.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$608.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
IP
|
$1,822.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.78 |
| Max. Negotiated Rate |
$1,366.50 |
| Rate for Payer: Adventist Health Commercial |
$364.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,251.71
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,233.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,233.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.50
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.66 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,140.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.14
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$845.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$637.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$586.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.66 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,140.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.14
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$845.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$637.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$586.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$317.66 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.66 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,188.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,188.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$118.48 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,205.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,089.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,030.18
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,140.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,086.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,086.34
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,316.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$864.04
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
