|
HC INSRT TUN CNTRL VAD W SUB PORT GT 5YR
|
Facility
|
IP
|
$13,679.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
909080012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,475.90 |
| Max. Negotiated Rate |
$10,259.25 |
| Rate for Payer: Adventist Health Commercial |
$2,735.80
|
| Rate for Payer: Cash Price |
$7,523.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,260.68
|
| Rate for Payer: Heritage Provider Network Senior |
$9,260.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,475.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,419.75
|
| Rate for Payer: Multiplan Commercial |
$10,259.25
|
|
|
HC INSRT TUN CNTRL VAD W SUB PORT GT 5YR
|
Facility
|
OP
|
$13,679.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
909080012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,259.25 |
| Rate for Payer: Adventist Health Commercial |
$2,735.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,397.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$7,523.45
|
| Rate for Payer: Cash Price |
$7,523.45
|
| Rate for Payer: Cash Price |
$7,523.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,891.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,467.30
|
| Rate for Payer: Heritage Provider Network Senior |
$4,919.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$420.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,598.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,475.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,419.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$10,259.25
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,399.13
|
| Rate for Payer: TriValley Medical Group Senior |
$4,399.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC INSRT TUN CNTRL VAD W/SUB PORT GT 5YR
|
Facility
|
OP
|
$13,679.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
900501569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,259.25 |
| Rate for Payer: Adventist Health Commercial |
$2,735.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,397.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$7,523.45
|
| Rate for Payer: Cash Price |
$7,523.45
|
| Rate for Payer: Cash Price |
$7,523.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,891.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,260.68
|
| Rate for Payer: Heritage Provider Network Senior |
$9,260.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,524.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,475.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,419.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$10,259.25
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,921.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,529.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC INSRT TUN CNTRL VAD W/SUB PORT GT 5YR
|
Facility
|
IP
|
$13,679.00
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
900501569
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,475.90 |
| Max. Negotiated Rate |
$10,259.25 |
| Rate for Payer: Adventist Health Commercial |
$2,735.80
|
| Rate for Payer: Cash Price |
$7,523.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,260.68
|
| Rate for Payer: Heritage Provider Network Senior |
$9,260.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,475.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,419.75
|
| Rate for Payer: Multiplan Commercial |
$10,259.25
|
|
|
HC INS STABL DEV WO DCMPRN
|
Facility
|
IP
|
$78,413.00
|
|
|
Service Code
|
CPT 22869
|
| Hospital Charge Code |
900102190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,192.75 |
| Max. Negotiated Rate |
$58,809.75 |
| Rate for Payer: Adventist Health Commercial |
$15,682.60
|
| Rate for Payer: Cash Price |
$43,127.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$53,085.60
|
| Rate for Payer: Heritage Provider Network Senior |
$53,085.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,192.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,603.25
|
| Rate for Payer: Multiplan Commercial |
$58,809.75
|
|
|
HC INS STABL DEV WO DCMPRN
|
Facility
|
OP
|
$78,413.00
|
|
|
Service Code
|
CPT 22869
|
| Hospital Charge Code |
900102190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$58,809.75 |
| Rate for Payer: Adventist Health Commercial |
$15,682.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$53,869.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,983.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,348.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$43,127.15
|
| Rate for Payer: Cash Price |
$43,127.15
|
| Rate for Payer: Cash Price |
$43,127.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50,968.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,983.44
|
| Rate for Payer: Dignity Health Senior |
$16,348.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,348.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$48,537.65
|
| Rate for Payer: Heritage Provider Network Senior |
$20,108.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$758.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,348.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31,062.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,192.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,800.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,603.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,599.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,599.21
|
| Rate for Payer: Multiplan Commercial |
$58,809.75
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$17,983.44
|
| Rate for Payer: TriValley Medical Group Senior |
$17,983.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,983.44
|
| Rate for Payer: Vantage Medical Group Senior |
$16,348.58
|
|
|
HC INS STBL DEV WO DCMPRN 2ND LVL
|
Facility
|
IP
|
$39,206.00
|
|
|
Service Code
|
CPT 22870
|
| Hospital Charge Code |
909020154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,096.29 |
| Max. Negotiated Rate |
$29,404.50 |
| Rate for Payer: Adventist Health Commercial |
$7,841.20
|
| Rate for Payer: Cash Price |
$21,563.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,542.46
|
| Rate for Payer: Heritage Provider Network Senior |
$26,542.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,096.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,801.50
|
| Rate for Payer: Multiplan Commercial |
$29,404.50
|
|
|
HC INS STBL DEV WO DCMPRN 2ND LVL
|
Facility
|
OP
|
$39,206.00
|
|
|
Service Code
|
CPT 22870
|
| Hospital Charge Code |
909020154
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$33,325.10 |
| Rate for Payer: Adventist Health Commercial |
$7,841.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,934.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,325.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,563.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29,404.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$21,563.30
|
| Rate for Payer: Cash Price |
$21,563.30
|
| Rate for Payer: Cash Price |
$21,563.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$25,483.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,325.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$33,325.10
|
| Rate for Payer: Dignity Health Senior |
$33,325.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$24,268.51
|
| Rate for Payer: Heritage Provider Network Senior |
$24,268.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$194.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$18,701.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,096.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,801.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,444.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,444.20
|
| Rate for Payer: Multiplan Commercial |
$29,404.50
|
| 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 |
$33,325.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33,325.10
|
| Rate for Payer: Vantage Medical Group Senior |
$33,325.10
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
IP
|
$14,325.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906813406
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,592.82 |
| Max. Negotiated Rate |
$10,743.75 |
| Rate for Payer: Adventist Health Commercial |
$2,865.00
|
| Rate for Payer: Cash Price |
$7,878.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,698.02
|
| Rate for Payer: Heritage Provider Network Senior |
$9,698.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,592.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,581.25
|
| Rate for Payer: Multiplan Commercial |
$10,743.75
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
OP
|
$14,325.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906813406
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19,979.37 |
| Rate for Payer: Adventist Health Commercial |
$2,865.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,841.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,878.75
|
| Rate for Payer: Cash Price |
$7,878.75
|
| Rate for Payer: Cash Price |
$7,878.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,311.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Senior |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,515.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,867.17
|
| Rate for Payer: Heritage Provider Network Senior |
$12,934.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,835.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19,979.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,592.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,092.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,581.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,249.48
|
| Rate for Payer: Multiplan Commercial |
$10,743.75
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,567.01
|
| Rate for Payer: TriValley Medical Group Senior |
$11,567.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
IP
|
$16,853.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906820138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,050.39 |
| Max. Negotiated Rate |
$12,639.75 |
| Rate for Payer: Adventist Health Commercial |
$3,370.60
|
| Rate for Payer: Cash Price |
$9,269.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,409.48
|
| Rate for Payer: Heritage Provider Network Senior |
$11,409.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,050.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,213.25
|
| Rate for Payer: Multiplan Commercial |
$12,639.75
|
|
|
HC INS SUBQ CAR RHYTHM MTR W PRGM
|
Facility
|
OP
|
$16,853.00
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
906820138
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19,979.37 |
| Rate for Payer: Adventist Health Commercial |
$3,370.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,578.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$9,269.15
|
| Rate for Payer: Cash Price |
$9,269.15
|
| Rate for Payer: Cash Price |
$9,269.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,954.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Senior |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,515.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,432.01
|
| Rate for Payer: Heritage Provider Network Senior |
$12,934.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,835.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19,979.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,050.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,092.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,213.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,249.48
|
| Rate for Payer: Multiplan Commercial |
$12,639.75
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,567.01
|
| Rate for Payer: TriValley Medical Group Senior |
$11,567.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC INST OR RPLCMT SPNL NEUROSTIM
|
Facility
|
OP
|
$142,285.00
|
|
|
Service Code
|
CPT 63685
|
| Hospital Charge Code |
900100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$106,713.75 |
| Rate for Payer: Adventist Health Commercial |
$28,457.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$97,749.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58,079.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42,591.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38,719.74
|
| 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 |
$78,256.75
|
| Rate for Payer: Cash Price |
$78,256.75
|
| Rate for Payer: Cash Price |
$78,256.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$92,485.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58,079.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,591.71
|
| Rate for Payer: Dignity Health Senior |
$38,719.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$85,371.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$38,719.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$88,074.41
|
| Rate for Payer: Heritage Provider Network Senior |
$47,625.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38,719.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$73,567.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,753.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44,527.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35,571.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48,786.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48,786.87
|
| Rate for Payer: Multiplan Commercial |
$106,713.75
|
| Rate for Payer: Multiplan WC |
$61,693.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$42,591.71
|
| Rate for Payer: TriValley Medical Group Senior |
$42,591.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$18,953.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,939.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58,079.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,591.71
|
| Rate for Payer: Vantage Medical Group Senior |
$38,719.74
|
|
|
HC INST OR RPLCMT SPNL NEUROSTIM
|
Facility
|
IP
|
$142,285.00
|
|
|
Service Code
|
CPT 63685
|
| Hospital Charge Code |
900100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25,753.58 |
| Max. Negotiated Rate |
$106,713.75 |
| Rate for Payer: Adventist Health Commercial |
$28,457.00
|
| Rate for Payer: Cash Price |
$78,256.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$96,326.95
|
| Rate for Payer: Heritage Provider Network Senior |
$96,326.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,753.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35,571.25
|
| Rate for Payer: Multiplan Commercial |
$106,713.75
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
OP
|
$9,164.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,832.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,898.16
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,295.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| 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 |
$5,040.20
|
| Rate for Payer: Cash Price |
$5,040.20
|
| Rate for Payer: Cash Price |
$5,040.20
|
| Rate for Payer: Cash Price |
$5,040.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,956.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,956.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,672.52
|
| Rate for Payer: Heritage Provider Network Senior |
$244.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$377.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,658.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,291.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$6,873.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
IP
|
$10,781.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820291
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,951.36 |
| Max. Negotiated Rate |
$8,085.75 |
| Rate for Payer: Adventist Health Commercial |
$2,156.20
|
| Rate for Payer: Cash Price |
$5,929.55
|
| Rate for Payer: Cash Price |
$5,929.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,951.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,695.25
|
| Rate for Payer: Multiplan Commercial |
$8,085.75
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
OP
|
$10,781.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820291
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$2,156.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,762.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,406.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| 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 |
$5,929.55
|
| Rate for Payer: Cash Price |
$5,929.55
|
| Rate for Payer: Cash Price |
$5,929.55
|
| Rate for Payer: Cash Price |
$5,929.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,007.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Senior |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,007.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$198.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,673.44
|
| Rate for Payer: Heritage Provider Network Senior |
$244.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$377.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,951.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,695.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.49
|
| Rate for Payer: Multiplan Commercial |
$8,085.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$218.68
|
| Rate for Payer: TriValley Medical Group Senior |
$198.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC INST WAVE FREE RATIO WO STRESS AGENT
|
Facility
|
IP
|
$9,164.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906803801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,658.68 |
| Max. Negotiated Rate |
$6,873.00 |
| Rate for Payer: Adventist Health Commercial |
$1,832.80
|
| Rate for Payer: Cash Price |
$5,040.20
|
| Rate for Payer: Cash Price |
$5,040.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,658.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,291.00
|
| Rate for Payer: Multiplan Commercial |
$6,873.00
|
|
|
HC INSULIN
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
900912130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$95.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$122.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.36
|
| Rate for Payer: Blue Shield of California Commercial |
$92.04
|
| Rate for Payer: Blue Shield of California EPN |
$73.83
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$116.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.57
|
| Rate for Payer: Dignity Health Senior |
$11.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$110.80
|
| Rate for Payer: Heritage Provider Network Senior |
$110.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.43
|
| Rate for Payer: TriValley Medical Group Senior |
$11.43
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.57
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
|
|
HC INSULIN
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
900912130
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Adventist Health Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$98.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.18
|
| Rate for Payer: Heritage Provider Network Senior |
$121.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.75
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
|
|
HC INTACT PTH
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
900910942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$572.25 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Cash Price |
$419.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$516.55
|
| Rate for Payer: Heritage Provider Network Senior |
$516.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.75
|
| Rate for Payer: Multiplan Commercial |
$572.25
|
|
|
HC INTACT PTH
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
CPT 83970
|
| Hospital Charge Code |
900910942
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$572.25 |
| Rate for Payer: Adventist Health Commercial |
$152.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$407.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$524.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$376.83
|
| Rate for Payer: Blue Shield of California Commercial |
$332.18
|
| Rate for Payer: Blue Shield of California EPN |
$266.44
|
| Rate for Payer: Cash Price |
$419.65
|
| Rate for Payer: Cash Price |
$419.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$495.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.41
|
| Rate for Payer: Dignity Health Senior |
$41.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$41.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$472.30
|
| Rate for Payer: Heritage Provider Network Senior |
$472.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$363.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.01
|
| Rate for Payer: Multiplan Commercial |
$572.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$41.28
|
| Rate for Payer: TriValley Medical Group Senior |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$44.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$44.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.41
|
| Rate for Payer: Vantage Medical Group Senior |
$41.28
|
|
|
HC INT AUDITORY MEATUS
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 70134
|
| Hospital Charge Code |
909001133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Adventist Health Commercial |
$84.60
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$286.37
|
| Rate for Payer: Heritage Provider Network Senior |
$286.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.75
|
| Rate for Payer: Multiplan Commercial |
$317.25
|
|
|
HC INT AUDITORY MEATUS
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 70134
|
| Hospital Charge Code |
909001133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$1,045.01 |
| Rate for Payer: Adventist Health Commercial |
$84.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$226.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$290.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.61
|
| Rate for Payer: Blue Shield of California Commercial |
$156.72
|
| Rate for Payer: Blue Shield of California EPN |
$126.03
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$274.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Senior |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.95
|
| Rate for Payer: EPIC Health Plan Medicare |
$696.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.84
|
| Rate for Payer: Heritage Provider Network Senior |
$261.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$201.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$801.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$877.80
|
| Rate for Payer: Multiplan Commercial |
$317.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$696.67
|
| Rate for Payer: TriValley Medical Group Senior |
$696.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC INTERCOSTAL NERVE BLOCK SINGLE
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
900501673
|
|
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 |
$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 |
$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 |
$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 |
$559.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$576.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,082.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.50
|
| 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 |
$168.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.00
|
| 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 |
$699.00
|
| 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
|
|
