|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$559.20
|
| Rate for Payer: Heritage Provider Network Senior |
$559.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.50
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$441.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$567.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Blue Shield of California Commercial |
$503.86
|
| Rate for Payer: Blue Shield of California EPN |
$403.09
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: Cash Price |
$454.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Senior |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$163.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$511.29
|
| Rate for Payer: Heritage Provider Network Senior |
$511.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$394.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.31
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$413.00
|
| Rate for Payer: TriValley Medical Group Senior |
$413.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$413.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$413.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.61 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$376.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$484.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$458.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Senior |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$252.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.29
|
| Rate for Payer: Heritage Provider Network Senior |
$477.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$336.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$318.11
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$253.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$233.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.61 |
| Max. Negotiated Rate |
$528.75 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$477.29
|
| Rate for Payer: Heritage Provider Network Senior |
$477.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.25
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
|
|
HC INJ AA AND OR STRD SUPCPLR NRV
|
Facility
|
IP
|
$1,902.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
909004418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.26 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Cash Price |
$1,046.10
|
| 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 INJ AA AND OR STRD SUPCPLR NRV
|
Facility
|
OP
|
$1,902.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
909004418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,306.67
|
| 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 |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,236.30
|
| 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 |
$1,141.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,177.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,082.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,671.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.50
|
| 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 |
$1,426.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$967.91
|
| Rate for Payer: TriValley Medical Group Senior |
$967.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| 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 INJ AA AND OR STROID PUNDL NRV
|
Facility
|
IP
|
$2,471.00
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
909004430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$447.25 |
| Max. Negotiated Rate |
$1,853.25 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,672.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,672.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.75
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
|
|
HC INJ AA AND OR STROID PUNDL NRV
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
909004430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,697.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,359.05
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,606.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,529.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ AA/STRD GNCLR NRV BRNCH
|
Facility
|
IP
|
$1,902.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
900100992
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.26 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Cash Price |
$1,046.10
|
| 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 INJ AA/STRD GNCLR NRV BRNCH
|
Facility
|
OP
|
$1,902.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
900100992
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,306.67
|
| 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 |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,236.30
|
| 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 |
$1,141.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,177.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,082.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$315.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,671.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.50
|
| 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 |
$1,426.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$967.91
|
| Rate for Payer: TriValley Medical Group Senior |
$967.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| 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 INJ ABDOMINAL SHUNT PREV PLCD
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
909049427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
|
HC INJ ABDOMINAL SHUNT PREV PLCD
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
909049427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$615.00
|
| 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 |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cash Price |
$451.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.00
|
| Rate for Payer: Dignity Health Senior |
$697.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$507.58
|
| Rate for Payer: Heritage Provider Network Senior |
$507.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$66.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$391.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$574.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$574.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.00
|
| Rate for Payer: Vantage Medical Group Senior |
$697.00
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.69 |
| Max. Negotiated Rate |
$699.00 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$630.96
|
| Rate for Payer: Heritage Provider Network Senior |
$630.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$186.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$640.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| 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 |
$512.60
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Cash Price |
$512.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$605.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Senior |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$559.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$375.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$576.91
|
| Rate for Payer: Heritage Provider Network Senior |
$461.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$712.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$431.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$472.59
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$412.58
|
| Rate for Payer: TriValley Medical Group Senior |
$412.58
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJ ANES ILIOING ILIOHYPO NRV
|
Facility
|
IP
|
$1,902.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
900100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.26 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Cash Price |
$1,046.10
|
| 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 INJ ANES ILIOING ILIOHYPO NRV
|
Facility
|
OP
|
$1,902.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
900100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,306.67
|
| 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 |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,236.30
|
| 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 |
$1,141.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,177.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,082.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,671.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.50
|
| 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 |
$1,426.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$967.91
|
| Rate for Payer: TriValley Medical Group Senior |
$967.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| 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 INJ ANES INTERCSTL NRV REG BLCK
|
Facility
|
IP
|
$2,430.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
909064421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.83 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$486.00
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,645.11
|
| Rate for Payer: Heritage Provider Network Senior |
$1,645.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.50
|
| Rate for Payer: Multiplan Commercial |
$1,822.50
|
|
|
HC INJ ANES INTERCSTL NRV REG BLCK
|
Facility
|
OP
|
$2,430.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
909064421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$486.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,669.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,579.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,458.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,504.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,822.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ ANES LUMBAR OR THORACIC
|
Facility
|
IP
|
$2,471.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
900100639
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$447.25 |
| Max. Negotiated Rate |
$1,853.25 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,672.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,672.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.75
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
|
|
HC INJ ANES LUMBAR OR THORACIC
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
900100639
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,697.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,359.05
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,606.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,529.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ ANES SCIATIC NRV SNGLE
|
Facility
|
IP
|
$1,902.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
900100636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.26 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Cash Price |
$1,046.10
|
| 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 INJ ANES SCIATIC NRV SNGLE
|
Facility
|
OP
|
$1,902.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
900100636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,306.67
|
| 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 |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cash Price |
$1,046.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,236.30
|
| 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 |
$1,141.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,177.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,082.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,671.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.50
|
| 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 |
$1,426.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$967.91
|
| Rate for Payer: TriValley Medical Group Senior |
$967.91
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| 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 INJ ANES STELLATE GANGLION
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
900100638
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,697.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,359.05
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,606.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,529.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ ANES STELLATE GANGLION
|
Facility
|
IP
|
$2,471.00
|
|
|
Service Code
|
CPT 64510
|
| Hospital Charge Code |
900100638
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$447.25 |
| Max. Negotiated Rate |
$1,853.25 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,672.87
|
| Rate for Payer: Heritage Provider Network Senior |
$1,672.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.75
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
|
|
HC INJ ANSTC AGT SPR HYPGTRC PLXS
|
Facility
|
OP
|
$2,471.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
909004517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$494.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,697.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,359.05
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Cash Price |
$1,359.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,606.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Senior |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,482.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,131.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,529.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,391.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$256.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,149.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$447.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,300.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,425.31
|
| Rate for Payer: Multiplan Commercial |
$1,853.25
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,244.32
|
| Rate for Payer: TriValley Medical Group Senior |
$1,244.32
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
