|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
OP
|
$44,264.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$33,198.00 |
| Rate for Payer: Adventist Health Commercial |
$8,852.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30,409.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27,001.04
|
| Rate for Payer: Blue Shield of California EPN |
$21,600.83
|
| Rate for Payer: Cash Price |
$24,345.20
|
| Rate for Payer: Cash Price |
$24,345.20
|
| Rate for Payer: Cash Price |
$24,345.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$28,771.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$28,771.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$27,399.42
|
| Rate for Payer: Heritage Provider Network Senior |
$27,399.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$21,113.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,011.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,066.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$33,198.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$14,409.33
|
| Rate for Payer: TriValley Medical Group Senior |
$14,409.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22,132.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$22,132.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
IP
|
$44,264.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8,011.78 |
| Max. Negotiated Rate |
$33,198.00 |
| Rate for Payer: Adventist Health Commercial |
$8,852.80
|
| Rate for Payer: Cash Price |
$24,345.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,966.73
|
| Rate for Payer: Heritage Provider Network Senior |
$29,966.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,011.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,066.00
|
| Rate for Payer: Multiplan Commercial |
$33,198.00
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
OP
|
$19,038.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,278.50 |
| Rate for Payer: Adventist Health Commercial |
$3,807.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,079.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$10,470.90
|
| Rate for Payer: Cash Price |
$10,470.90
|
| Rate for Payer: Cash Price |
$10,470.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,374.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,784.52
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,222.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,445.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,759.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$14,278.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
IP
|
$19,038.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,445.88 |
| Max. Negotiated Rate |
$14,278.50 |
| Rate for Payer: Adventist Health Commercial |
$3,807.60
|
| Rate for Payer: Cash Price |
$10,470.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,888.73
|
| Rate for Payer: Heritage Provider Network Senior |
$12,888.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,445.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,759.50
|
| Rate for Payer: Multiplan Commercial |
$14,278.50
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
IP
|
$1,145.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.25 |
| Max. Negotiated Rate |
$858.75 |
| Rate for Payer: Adventist Health Commercial |
$229.00
|
| Rate for Payer: Cash Price |
$629.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$775.16
|
| Rate for Payer: Heritage Provider Network Senior |
$775.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.25
|
| Rate for Payer: Multiplan Commercial |
$858.75
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
OP
|
$1,145.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.25 |
| Max. Negotiated Rate |
$858.75 |
| Rate for Payer: Adventist Health Commercial |
$229.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$612.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$786.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.66
|
| Rate for Payer: Blue Shield of California Commercial |
$274.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.91
|
| Rate for Payer: Cash Price |
$629.75
|
| Rate for Payer: Cash Price |
$629.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$744.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Senior |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$744.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$226.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$708.75
|
| Rate for Payer: Heritage Provider Network Senior |
$708.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$589.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$546.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$260.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$858.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$226.19
|
| Rate for Payer: TriValley Medical Group Senior |
$226.19
|
| 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 |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC ENTEROSCOPY SUBMCSL INJ
|
Facility
|
IP
|
$3,548.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906765000
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$642.19 |
| Max. Negotiated Rate |
$2,661.00 |
| Rate for Payer: Adventist Health Commercial |
$709.60
|
| Rate for Payer: Cash Price |
$1,951.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,402.00
|
| Rate for Payer: Heritage Provider Network Senior |
$2,402.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.00
|
| Rate for Payer: Multiplan Commercial |
$2,661.00
|
|
|
HC ENTEROSCOPY SUBMCSL INJ
|
Facility
|
OP
|
$3,548.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906765000
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$709.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,437.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| 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 |
$1,951.40
|
| Rate for Payer: Cash Price |
$1,951.40
|
| Rate for Payer: Cash Price |
$1,951.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,306.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Senior |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,191.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,196.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,692.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,500.99
|
| Rate for Payer: Multiplan Commercial |
$2,661.00
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.99
|
| Rate for Payer: Heritage Provider Network Senior |
$64.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.95
|
| 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 |
$23.36
|
| Rate for Payer: Blue Shield of California Commercial |
$20.45
|
| Rate for Payer: Blue Shield of California EPN |
$16.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.40
|
| 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 |
$62.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$2.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.42
|
| Rate for Payer: Heritage Provider Network Senior |
$59.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| 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 |
$72.00
|
| 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
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$83.92
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$107.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.69
|
| 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 |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$38.25
|
| Rate for Payer: Blue Shield of California EPN |
$30.68
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$102.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.37
|
| Rate for Payer: Dignity Health Senior |
$5.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$97.18
|
| Rate for Payer: Heritage Provider Network Senior |
$97.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$74.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| 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 |
$117.75
|
| 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 |
$8.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$117.75 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$106.29
|
| Rate for Payer: Heritage Provider Network Senior |
$106.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.25
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
|
|
HC EPHYS EVAL CCM DFIB LD INITIAL IMPL
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
CPT 0930T
|
| Hospital Charge Code |
906811514
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$634.22 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$700.80
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$634.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.00
|
| Rate for Payer: Multiplan Commercial |
$2,628.00
|
|
|
HC EPHYS EVAL CCM DFIB LD INITIAL IMPL
|
Facility
|
OP
|
$3,504.00
|
|
|
Service Code
|
CPT 0930T
|
| Hospital Charge Code |
906811514
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$700.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,407.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| 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 |
$1,927.20
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,277.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Senior |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,542.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,168.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,897.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,930.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$634.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,773.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,943.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,943.55
|
| Rate for Payer: Multiplan Commercial |
$2,628.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,696.75
|
| Rate for Payer: TriValley Medical Group Senior |
$1,542.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPHYS EVAL CCM DFIB LD SEPARATE
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
CPT 0931T
|
| Hospital Charge Code |
906811515
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$634.22 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$700.80
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$634.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.00
|
| Rate for Payer: Multiplan Commercial |
$2,628.00
|
|
|
HC EPHYS EVAL CCM DFIB LD SEPARATE
|
Facility
|
OP
|
$3,504.00
|
|
|
Service Code
|
CPT 0931T
|
| Hospital Charge Code |
906811515
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$700.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,407.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,542.50
|
| 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 |
$1,927.20
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cash Price |
$1,927.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,277.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,696.75
|
| Rate for Payer: Dignity Health Senior |
$1,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,542.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,168.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,897.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,542.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,930.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$634.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,773.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$876.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,943.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,943.55
|
| Rate for Payer: Multiplan Commercial |
$2,628.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,696.75
|
| Rate for Payer: TriValley Medical Group Senior |
$1,542.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,313.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,696.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,542.50
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
OP
|
$2,409.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$481.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,654.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$1,324.95
|
| Rate for Payer: Cash Price |
$1,324.95
|
| Rate for Payer: Cash Price |
$1,324.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,565.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Senior |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,324.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,630.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,630.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,149.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$436.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,672.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,928.52
|
| Rate for Payer: Multiplan Commercial |
$1,806.75
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$866.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$797.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
IP
|
$2,409.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.03 |
| Max. Negotiated Rate |
$1,806.75 |
| Rate for Payer: Adventist Health Commercial |
$481.80
|
| Rate for Payer: Cash Price |
$1,324.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,630.89
|
| Rate for Payer: Heritage Provider Network Senior |
$1,630.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$436.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.25
|
| Rate for Payer: Multiplan Commercial |
$1,806.75
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,316.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,169.37
|
| Rate for Payer: Blue Shield of California EPN |
$935.50
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,246.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Senior |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,186.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,186.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$914.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.70
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$967.91
|
| Rate for Payer: TriValley Medical Group Senior |
$879.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,316.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,246.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Senior |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$914.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.70
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$689.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$634.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$1,437.75 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,316.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,169.37
|
| Rate for Payer: Blue Shield of California EPN |
$935.50
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,246.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Senior |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,186.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,186.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$914.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.70
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$967.91
|
| Rate for Payer: TriValley Medical Group Senior |
$879.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$1,437.75 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$1,437.75 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,316.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,246.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Senior |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,246.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,297.81
|
| Rate for Payer: Heritage Provider Network Senior |
$1,297.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$914.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,108.70
|
| Rate for Payer: Multiplan Commercial |
$1,437.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$689.74
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$634.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
