|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
IP
|
$1,902.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811387
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$344.26 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Cash Price |
$855.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.65
|
| Rate for Payer: Heritage Provider Network Senior |
$1,287.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.50
|
| Rate for Payer: Multiplan Commercial |
$1,426.50
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
IP
|
$2,709.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820131
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$490.33 |
| Max. Negotiated Rate |
$2,031.75 |
| Rate for Payer: Adventist Health Commercial |
$541.80
|
| Rate for Payer: Cash Price |
$1,219.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,833.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,833.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.25
|
| Rate for Payer: Multiplan Commercial |
$2,031.75
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
OP
|
$2,709.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820131
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$85.86 |
| Max. Negotiated Rate |
$2,302.65 |
| Rate for Payer: Adventist Health Commercial |
$541.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,447.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,861.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,302.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,489.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,031.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,652.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,321.99
|
| Rate for Payer: Cash Price |
$1,219.05
|
| Rate for Payer: Cash Price |
$1,219.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,760.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,302.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,302.65
|
| Rate for Payer: Dignity Health Senior |
$2,302.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,760.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,676.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,676.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,292.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,896.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,896.30
|
| Rate for Payer: Multiplan Commercial |
$2,031.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,354.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,354.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,302.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,302.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,302.65
|
|
|
HC ILEOSCOPY STOMA W BX
|
Facility
|
IP
|
$2,727.00
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
906744382
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$493.59 |
| Max. Negotiated Rate |
$2,045.25 |
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
|
|
HC ILEOSCOPY STOMA W BX
|
Facility
|
OP
|
$5,368.00
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
906744382
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,073.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,687.82
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,489.20
|
| 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 |
$3,322.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,560.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$971.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.00
|
| 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 |
$4,026.00
|
| 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 ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
IP
|
$2,727.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$493.59 |
| Max. Negotiated Rate |
$2,045.25 |
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
OP
|
$5,368.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,073.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,687.82
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,489.20
|
| 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 |
$3,634.14
|
| Rate for Payer: Heritage Provider Network Senior |
$3,634.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,560.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$971.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.00
|
| 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 |
$4,026.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,931.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,777.34
|
| 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 ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
IP
|
$2,727.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$493.59 |
| Max. Negotiated Rate |
$2,045.25 |
| Rate for Payer: Adventist Health Commercial |
$545.40
|
| Rate for Payer: Cash Price |
$1,227.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,846.18
|
| Rate for Payer: Heritage Provider Network Senior |
$1,846.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.75
|
| Rate for Payer: Multiplan Commercial |
$2,045.25
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
OP
|
$5,368.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,073.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,687.82
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,489.20
|
| 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 |
$3,322.79
|
| Rate for Payer: Heritage Provider Network Senior |
$1,465.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,560.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$971.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,342.00
|
| 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 |
$4,026.00
|
| 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 ILEOSCOPY W/STNT PLCMNT
|
Facility
|
IP
|
$7,685.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,390.98 |
| Max. Negotiated Rate |
$5,763.75 |
| Rate for Payer: Adventist Health Commercial |
$1,537.00
|
| Rate for Payer: Cash Price |
$3,458.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,202.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5,202.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,390.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,921.25
|
| Rate for Payer: Multiplan Commercial |
$5,763.75
|
|
|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
|
OP
|
$8,470.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,694.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,818.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,505.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Senior |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,410.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,242.93
|
| Rate for Payer: Heritage Provider Network Senior |
$2,964.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,040.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,533.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,771.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,037.00
|
| Rate for Payer: Multiplan Commercial |
$6,352.50
|
| 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 |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
OP
|
$5,944.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,188.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,083.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$2,674.80
|
| Rate for Payer: Cash Price |
$2,674.80
|
| Rate for Payer: Cash Price |
$2,674.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,863.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,679.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$298.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,075.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$4,458.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| 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 |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
IP
|
$5,944.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,075.86 |
| Max. Negotiated Rate |
$4,458.00 |
| Rate for Payer: Adventist Health Commercial |
$1,188.80
|
| Rate for Payer: Cash Price |
$2,674.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,024.09
|
| Rate for Payer: Heritage Provider Network Senior |
$4,024.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,075.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.00
|
| Rate for Payer: Multiplan Commercial |
$4,458.00
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
OP
|
$4,331.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$866.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,975.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,948.95
|
| Rate for Payer: Cash Price |
$1,948.95
|
| Rate for Payer: Cash Price |
$1,948.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,815.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,680.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$963.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$783.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$3,248.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| 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 |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
IP
|
$4,331.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$783.91 |
| Max. Negotiated Rate |
$3,248.25 |
| Rate for Payer: Adventist Health Commercial |
$866.20
|
| Rate for Payer: Cash Price |
$1,948.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,932.09
|
| Rate for Payer: Heritage Provider Network Senior |
$2,932.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$783.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.75
|
| Rate for Payer: Multiplan Commercial |
$3,248.25
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
IP
|
$4,523.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$818.66 |
| Max. Negotiated Rate |
$3,392.25 |
| Rate for Payer: Adventist Health Commercial |
$904.60
|
| Rate for Payer: Cash Price |
$2,035.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,062.07
|
| Rate for Payer: Heritage Provider Network Senior |
$3,062.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$818.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.75
|
| Rate for Payer: Multiplan Commercial |
$3,392.25
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH VISCERAL, PERC
|
Facility
|
OP
|
$4,523.00
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
900100010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$904.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,107.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$2,035.35
|
| Rate for Payer: Cash Price |
$2,035.35
|
| Rate for Payer: Cash Price |
$2,035.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,939.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Senior |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,058.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,799.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,532.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$297.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,911.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$818.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,367.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,130.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,593.94
|
| Rate for Payer: Multiplan Commercial |
$3,392.25
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,264.55
|
| Rate for Payer: TriValley Medical Group Senior |
$2,264.55
|
| 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 |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC IMIPENEM E TEST
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$77.25 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.73
|
| Rate for Payer: Heritage Provider Network Senior |
$69.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
|
|
HC IMIPENEM E TEST
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912423
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$23.16 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.59
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| 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 |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Senior |
$11.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$245.36 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$14.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.36
|
| Rate for Payer: Blue Shield of California Commercial |
$215.48
|
| Rate for Payer: Blue Shield of California EPN |
$172.83
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.31
|
| Rate for Payer: Dignity Health Senior |
$35.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$35.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.33
|
| Rate for Payer: Heritage Provider Network Senior |
$17.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.03
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$35.74
|
| Rate for Payer: TriValley Medical Group Senior |
$35.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$38.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$38.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.31
|
| Rate for Payer: Vantage Medical Group Senior |
$35.74
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
900912028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.96
|
| Rate for Payer: Heritage Provider Network Senior |
$18.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
OP
|
$131.04
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$53.73
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$90.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$52.68
|
| Rate for Payer: Blue Shield of California EPN |
$52.68
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.38
|
| Rate for Payer: Dignity Health Senior |
$111.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.67
|
| Rate for Payer: Heritage Provider Network Senior |
$60.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.73
|
| Rate for Payer: Multiplan Commercial |
$98.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.38
|
| Rate for Payer: Vantage Medical Group Senior |
$111.38
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 20"
|
Facility
|
IP
|
$131.04
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698369
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$26.21
|
| Rate for Payer: Aetna of CA Gatekeeper |
$62.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$52.68
|
| Rate for Payer: Blue Shield of California EPN |
$52.68
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cigna of CA HMO/PPO |
$60.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.67
|
| Rate for Payer: Heritage Provider Network Senior |
$60.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$65.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.76
|
| Rate for Payer: Multiplan Commercial |
$98.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$47.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$43.39
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 24"
|
Facility
|
OP
|
$161.63
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698368
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.41 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$66.27
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$88.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$64.98
|
| Rate for Payer: Blue Shield of California EPN |
$64.98
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.39
|
| Rate for Payer: Dignity Health Senior |
$137.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.83
|
| Rate for Payer: Heritage Provider Network Senior |
$74.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.14
|
| Rate for Payer: Multiplan Commercial |
$121.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$58.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$53.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.39
|
| Rate for Payer: Vantage Medical Group Senior |
$137.39
|
|
|
HC IMMOBILIZER KNEE 3-PANEL 24"
|
Facility
|
IP
|
$161.63
|
|
|
Service Code
|
CPT L1830
|
| Hospital Charge Code |
901698368
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$32.33
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$64.98
|
| Rate for Payer: Blue Shield of California EPN |
$64.98
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cash Price |
$72.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$74.83
|
| Rate for Payer: Heritage Provider Network Senior |
$74.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$80.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.41
|
| Rate for Payer: Multiplan Commercial |
$121.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$58.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$53.52
|
|
