|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$230.57 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$375.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,290.19
|
| 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 |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,220.70
|
| 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 |
$1,126.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,162.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.77
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.57
|
| 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 |
$339.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.50
|
| 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 |
$1,408.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$950.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| 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
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
OP
|
$2,632.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$526.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,808.18
|
| 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 |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,710.80
|
| 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 |
$1,579.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,629.21
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.77
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$343.25
|
| 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 |
$476.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.00
|
| 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 |
$1,974.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$950.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| 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
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
IP
|
$2,632.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$476.39 |
| Max. Negotiated Rate |
$1,974.00 |
| Rate for Payer: Adventist Health Commercial |
$526.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,808.18
|
| Rate for Payer: Cash Price |
$1,184.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,781.86
|
| Rate for Payer: Heritage Provider Network Senior |
$1,781.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.00
|
| Rate for Payer: Multiplan Commercial |
$1,974.00
|
|
|
HC INJ INTER LMBR/SAC WO GUID
|
Facility
|
OP
|
$1,878.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.06 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$375.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,290.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$845.10
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,220.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,126.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,162.48
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$216.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$1,408.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ INTER LMBR/SAC WO GUID
|
Facility
|
IP
|
$1,878.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$339.92 |
| Max. Negotiated Rate |
$1,408.50 |
| Rate for Payer: Adventist Health Commercial |
$375.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,290.19
|
| Rate for Payer: Cash Price |
$845.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,271.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,271.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.50
|
| Rate for Payer: Multiplan Commercial |
$1,408.50
|
|
|
HC INJ LMBR/SAC INC CATH W GUID
|
Facility
|
OP
|
$3,953.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
907262327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$313.62 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$790.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,715.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$1,778.85
|
| Rate for Payer: Cash Price |
$1,778.85
|
| Rate for Payer: Cash Price |
$1,778.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,569.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,371.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,446.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$313.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$988.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$2,964.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ LMBR/SAC INC CATH W GUID
|
Facility
|
IP
|
$3,953.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
907262327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$715.49 |
| Max. Negotiated Rate |
$2,964.75 |
| Rate for Payer: Adventist Health Commercial |
$790.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,715.71
|
| Rate for Payer: Cash Price |
$1,778.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,676.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2,676.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$988.25
|
| Rate for Payer: Multiplan Commercial |
$2,964.75
|
|
|
HC INJ LMBR/SAC INC CATH WO GUID
|
Facility
|
OP
|
$4,522.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
907262326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.82 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$904.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,106.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$2,034.90
|
| Rate for Payer: Cash Price |
$2,034.90
|
| Rate for Payer: Cash Price |
$2,034.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,939.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: Dignity Health Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,713.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,138.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,799.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,400.76
|
| Rate for Payer: Humana Medicare |
$1,138.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,163.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$818.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,343.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.93
|
| Rate for Payer: Multiplan Commercial |
$3,391.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,252.71
|
| Rate for Payer: TriValley Medical Group Senior |
$1,252.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ LMBR/SAC INC CATH WO GUID
|
Facility
|
IP
|
$4,522.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
907262326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$818.48 |
| Max. Negotiated Rate |
$3,391.50 |
| Rate for Payer: Adventist Health Commercial |
$904.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,106.61
|
| Rate for Payer: Cash Price |
$2,034.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,061.39
|
| Rate for Payer: Heritage Provider Network Senior |
$3,061.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$818.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.50
|
| Rate for Payer: Multiplan Commercial |
$3,391.50
|
|
|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$293.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$279.17
|
| Rate for Payer: Heritage Provider Network Senior |
$612.79
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$946.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$548.02
|
| Rate for Payer: TriValley Medical Group Senior |
$548.02
|
| 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 Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.63 |
| Max. Negotiated Rate |
$338.25 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$309.84
|
| Rate for Payer: Cash Price |
$202.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$305.33
|
| Rate for Payer: Heritage Provider Network Senior |
$305.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.75
|
| Rate for Payer: Multiplan Commercial |
$338.25
|
|
|
HC INJ SCLEROSING SOLUTION HEMORR
|
Facility
|
IP
|
$2,914.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.43 |
| Max. Negotiated Rate |
$2,185.50 |
| Rate for Payer: Adventist Health Commercial |
$582.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.92
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.50
|
| Rate for Payer: Multiplan Commercial |
$2,185.50
|
|
|
HC INJ SCLEROSING SOLUTION HEMORR
|
Facility
|
OP
|
$2,914.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$582.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$258.94
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,894.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: Dignity Health Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,141.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.78
|
| Rate for Payer: Humana Medicare |
$1,141.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,404.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,347.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,438.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,438.83
|
| Rate for Payer: Multiplan Commercial |
$2,185.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,058.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$973.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC INJ SULFUR HEXA LUMASON PER ML
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT Q9950
|
| Hospital Charge Code |
906609950
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$46.46
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.92
|
| Rate for Payer: Blue Shield of California Commercial |
$103.09
|
| Rate for Payer: Blue Shield of California EPN |
$97.44
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Senior |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.75
|
| Rate for Payer: Heritage Provider Network Senior |
$102.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$66.40
|
| Rate for Payer: TriValley Medical Group Senior |
$66.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC INJ SULFUR HEXA LUMASON PER ML
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT Q9950
|
| Hospital Charge Code |
906609950
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$114.04
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.38
|
| Rate for Payer: Heritage Provider Network Senior |
$112.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$384.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$366.45
|
| Rate for Payer: Heritage Provider Network Senior |
$455.17
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$407.07
|
| Rate for Payer: TriValley Medical Group Senior |
$407.07
|
| 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 Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$400.78
|
| Rate for Payer: Heritage Provider Network Senior |
$400.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
IP
|
$592.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$400.78
|
| Rate for Payer: Heritage Provider Network Senior |
$400.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
|
|
HC INJ TEN SHEATH LIG TRIG PNTS
|
Facility
|
OP
|
$592.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
900501052
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$118.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$406.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$384.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$400.78
|
| Rate for Payer: Heritage Provider Network Senior |
$400.78
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$285.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$214.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$197.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
IP
|
$1,673.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$302.81 |
| Max. Negotiated Rate |
$1,254.75 |
| Rate for Payer: Adventist Health Commercial |
$334.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,149.35
|
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,132.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,132.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.25
|
| Rate for Payer: Multiplan Commercial |
$1,254.75
|
|
|
HC INJ TRIGGER PTS 3+
|
Facility
|
OP
|
$1,673.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
909000261
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$334.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,149.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,038.93
|
| Rate for Payer: Blue Shield of California EPN |
$982.05
|
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,087.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: Dignity Health Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$370.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,035.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,035.59
|
| Rate for Payer: Humana Medicare |
$370.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$703.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$466.28
|
| Rate for Payer: Multiplan Commercial |
$1,254.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$370.06
|
| Rate for Payer: TriValley Medical Group Senior |
$370.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$1,732.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$313.49 |
| Max. Negotiated Rate |
$1,299.00 |
| Rate for Payer: Adventist Health Commercial |
$346.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,189.88
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,172.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,172.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.00
|
| Rate for Payer: Multiplan Commercial |
$1,299.00
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$1,732.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906811385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$313.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$346.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,189.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,472.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$952.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,299.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,472.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,472.20
|
| Rate for Payer: Dignity Health Senior |
$1,472.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,072.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,072.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$448.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$834.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.00
|
| Rate for Payer: Multiplan Commercial |
$1,299.00
|
| 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 |
$1,472.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,472.20
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906820129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.30 |
| Max. Negotiated Rate |
$477.75 |
| Rate for Payer: Adventist Health Commercial |
$127.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$437.62
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.25
|
| Rate for Payer: Heritage Provider Network Senior |
$431.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.25
|
| Rate for Payer: Multiplan Commercial |
$477.75
|
|
|
HC INJ VENOGRAPHY EXTREMITY
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
906820129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$127.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$437.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$541.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$350.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$477.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$541.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$541.45
|
| Rate for Payer: Dignity Health Senior |
$541.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$394.30
|
| Rate for Payer: Heritage Provider Network Senior |
$394.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$448.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$307.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.25
|
| Rate for Payer: Multiplan Commercial |
$477.75
|
| 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 |
$541.45
|
| Rate for Payer: Vantage Medical Group Senior |
$541.45
|
|
