|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
OP
|
$4,248.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$768.89 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$849.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,918.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cash Price |
$1,911.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,761.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: Dignity Health Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,906.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,875.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,875.90
|
| Rate for Payer: Humana Medicare |
$3,906.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,047.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$768.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,062.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,921.79
|
| Rate for Payer: Multiplan Commercial |
$3,186.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,542.45
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,419.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.73 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$378.54
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$373.03
|
| Rate for Payer: Heritage Provider Network Senior |
$373.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.75
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.77
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$378.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.99
|
| Rate for Payer: Blue Shield of California Commercial |
$104.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.57
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$358.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$341.07
|
| Rate for Payer: Heritage Provider Network Senior |
$341.07
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.22 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$68.54
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$610.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.49
|
| Rate for Payer: Blue Shield of California Commercial |
$137.00
|
| Rate for Payer: Blue Shield of California EPN |
$77.91
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$577.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$549.67
|
| Rate for Payer: Heritage Provider Network Senior |
$549.67
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$666.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.73 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$610.06
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$601.18
|
| Rate for Payer: Heritage Provider Network Senior |
$601.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Multiplan Commercial |
$666.00
|
|
|
HC PENILE INJECTION
|
Facility
|
IP
|
$1,182.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.94 |
| Max. Negotiated Rate |
$886.50 |
| Rate for Payer: Adventist Health Commercial |
$236.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$812.03
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$800.21
|
| Rate for Payer: Heritage Provider Network Senior |
$800.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.50
|
| Rate for Payer: Multiplan Commercial |
$886.50
|
|
|
HC PENILE INJECTION
|
Facility
|
OP
|
$1,182.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$236.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$174.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$812.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$768.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: Dignity Health Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$308.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$800.21
|
| Rate for Payer: Heritage Provider Network Senior |
$800.21
|
| Rate for Payer: Humana Medicare |
$308.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$569.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$364.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.08
|
| Rate for Payer: Multiplan Commercial |
$886.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$429.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$394.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
|
OP
|
$1,614.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,210.50 |
| Rate for Payer: Adventist Health Commercial |
$322.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$272.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,108.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$904.69
|
| Rate for Payer: Blue Shield of California EPN |
$514.47
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,049.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$999.07
|
| Rate for Payer: Heritage Provider Network Senior |
$999.07
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$258.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$1,210.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$151.10
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,025.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$864.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
|
IP
|
$1,614.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$292.13 |
| Max. Negotiated Rate |
$1,210.50 |
| Rate for Payer: Adventist Health Commercial |
$322.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,108.82
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,092.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,092.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.50
|
| Rate for Payer: Multiplan Commercial |
$1,210.50
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
|
IP
|
$10,290.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,862.49 |
| Max. Negotiated Rate |
$7,717.50 |
| Rate for Payer: Adventist Health Commercial |
$2,058.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,069.23
|
| Rate for Payer: Cash Price |
$4,630.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,966.33
|
| Rate for Payer: Heritage Provider Network Senior |
$6,966.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,862.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,572.50
|
| Rate for Payer: Multiplan Commercial |
$7,717.50
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
|
OP
|
$10,290.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,862.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,058.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,069.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$4,630.50
|
| Rate for Payer: Cash Price |
$4,630.50
|
| Rate for Payer: Cash Price |
$4,630.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,688.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,369.51
|
| Rate for Payer: Heritage Provider Network Senior |
$5,316.82
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,911.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,212.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,862.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,572.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: Multiplan Commercial |
$7,717.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,754.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4,754.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
|
OP
|
$10,290.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,862.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,058.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,069.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,379.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,623.32
|
| Rate for Payer: Cash Price |
$4,630.50
|
| Rate for Payer: Cash Price |
$4,630.50
|
| Rate for Payer: Cash Price |
$4,630.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,688.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,369.51
|
| Rate for Payer: Heritage Provider Network Senior |
$5,316.82
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,352.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,212.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,862.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,572.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: Multiplan Commercial |
$7,717.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,754.88
|
| Rate for Payer: TriValley Medical Group Senior |
$4,754.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
|
IP
|
$10,290.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,862.49 |
| Max. Negotiated Rate |
$7,717.50 |
| Rate for Payer: Adventist Health Commercial |
$2,058.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,069.23
|
| Rate for Payer: Cash Price |
$4,630.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,966.33
|
| Rate for Payer: Heritage Provider Network Senior |
$6,966.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,862.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,572.50
|
| Rate for Payer: Multiplan Commercial |
$7,717.50
|
|
|
HC PERC CECOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$7,477.00
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
909000215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,353.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,495.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,136.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$3,364.65
|
| Rate for Payer: Cash Price |
$3,364.65
|
| Rate for Payer: Cash Price |
$3,364.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,860.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: Dignity Health Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,474.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,628.26
|
| Rate for Payer: Heritage Provider Network Senior |
$1,813.54
|
| Rate for Payer: Humana Medicare |
$1,474.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,390.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,801.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,353.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,857.77
|
| Rate for Payer: Multiplan Commercial |
$5,607.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,621.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,621.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC PERC CECOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$7,477.00
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
909000215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,353.34 |
| Max. Negotiated Rate |
$5,607.75 |
| Rate for Payer: Adventist Health Commercial |
$1,495.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,136.70
|
| Rate for Payer: Cash Price |
$3,364.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,061.93
|
| Rate for Payer: Heritage Provider Network Senior |
$5,061.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,353.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.25
|
| Rate for Payer: Multiplan Commercial |
$5,607.75
|
|
|
HC PERC DRAINAGE W CATH PLACEMENT
|
Facility
|
IP
|
$1,826.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
906601707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,369.50 |
| Rate for Payer: Adventist Health Commercial |
$365.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,254.46
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,236.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,236.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.50
|
| Rate for Payer: Multiplan Commercial |
$1,369.50
|
|
|
HC PERC DRAINAGE W CATH PLACEMENT
|
Facility
|
OP
|
$1,826.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
906601707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$163.05 |
| Max. Negotiated Rate |
$1,552.10 |
| Rate for Payer: Adventist Health Commercial |
$365.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,254.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,552.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,004.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,369.50
|
| Rate for Payer: Blue Shield of California Commercial |
$645.50
|
| Rate for Payer: Blue Shield of California EPN |
$367.08
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,186.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,552.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,552.10
|
| Rate for Payer: Dignity Health Senior |
$1,552.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.29
|
| Rate for Payer: Heritage Provider Network Senior |
$1,130.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$163.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$880.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.50
|
| Rate for Payer: Multiplan Commercial |
$1,369.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,552.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,552.10
|
|
|
HC PERC PLCMNT FIDUCIAL MRKR
|
Facility
|
OP
|
$3,119.00
|
|
|
Service Code
|
CPT 32553
|
| Hospital Charge Code |
900832553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$564.54 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$623.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,142.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,904.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,731.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,027.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,904.36
|
| Rate for Payer: Dignity Health Senior |
$1,731.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,731.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,930.66
|
| Rate for Payer: Heritage Provider Network Senior |
$2,129.43
|
| Rate for Payer: Humana Medicare |
$1,731.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$810.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,731.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,289.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$564.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,042.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$779.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,181.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,181.36
|
| Rate for Payer: Multiplan Commercial |
$2,339.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,904.36
|
| Rate for Payer: TriValley Medical Group Senior |
$1,904.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,596.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,904.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,731.24
|
|
|
HC PERC PLCMNT FIDUCIAL MRKR
|
Facility
|
IP
|
$3,119.00
|
|
|
Service Code
|
CPT 32553
|
| Hospital Charge Code |
900832553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$564.54 |
| Max. Negotiated Rate |
$2,339.25 |
| Rate for Payer: Adventist Health Commercial |
$623.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,142.75
|
| Rate for Payer: Cash Price |
$1,403.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,111.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2,111.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$564.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$779.75
|
| Rate for Payer: Multiplan Commercial |
$2,339.25
|
|
|
HC PERC PULM ART STENT ABN BI
|
Facility
|
OP
|
$31,065.00
|
|
|
Service Code
|
CPT 33903
|
| Hospital Charge Code |
906820326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,022.94 |
| Max. Negotiated Rate |
$26,115.92 |
| Rate for Payer: Adventist Health Commercial |
$6,213.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,341.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,745.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$13,979.25
|
| Rate for Payer: Cash Price |
$13,979.25
|
| Rate for Payer: Cash Price |
$13,979.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20,192.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,119.74
|
| Rate for Payer: Dignity Health Senior |
$13,745.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$13,745.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,229.24
|
| Rate for Payer: Heritage Provider Network Senior |
$16,906.62
|
| Rate for Payer: Humana Medicare |
$13,745.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,745.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26,115.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,622.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,219.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,766.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,318.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,318.98
|
| Rate for Payer: Multiplan Commercial |
$23,298.75
|
| Rate for Payer: Multiplan WC |
$18,791.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,119.74
|
| Rate for Payer: TriValley Medical Group Senior |
$15,119.74
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,617.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,119.74
|
| Rate for Payer: Vantage Medical Group Senior |
$13,745.22
|
|
|
HC PERC PULM ART STENT ABN BI
|
Facility
|
IP
|
$31,065.00
|
|
|
Service Code
|
CPT 33903
|
| Hospital Charge Code |
906820326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,622.76 |
| Max. Negotiated Rate |
$23,298.75 |
| Rate for Payer: Adventist Health Commercial |
$6,213.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$21,341.66
|
| Rate for Payer: Cash Price |
$13,979.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,031.00
|
| Rate for Payer: Heritage Provider Network Senior |
$21,031.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,622.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,766.25
|
| Rate for Payer: Multiplan Commercial |
$23,298.75
|
|
|
HC PERC PULM ART STENT ABN UNI
|
Facility
|
OP
|
$47,756.00
|
|
|
Service Code
|
CPT 33902
|
| Hospital Charge Code |
906820322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,022.94 |
| Max. Negotiated Rate |
$41,627.02 |
| Rate for Payer: Adventist Health Commercial |
$9,551.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,935.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32,808.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21,908.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,496.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$21,490.20
|
| Rate for Payer: Cash Price |
$21,490.20
|
| Rate for Payer: Cash Price |
$21,490.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31,041.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,099.86
|
| Rate for Payer: Dignity Health Senior |
$21,908.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$21,908.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$29,560.96
|
| Rate for Payer: Heritage Provider Network Senior |
$26,948.02
|
| Rate for Payer: Humana Medicare |
$21,908.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21,908.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$41,627.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,643.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,852.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,939.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,605.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27,605.29
|
| Rate for Payer: Multiplan Commercial |
$35,817.00
|
| Rate for Payer: Multiplan WC |
$29,952.68
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,099.86
|
| Rate for Payer: TriValley Medical Group Senior |
$24,099.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,002.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$14,303.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,863.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,099.86
|
| Rate for Payer: Vantage Medical Group Senior |
$21,908.96
|
|
|
HC PERC PULM ART STENT ABN UNI
|
Facility
|
IP
|
$47,756.00
|
|
|
Service Code
|
CPT 33902
|
| Hospital Charge Code |
906820322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,643.84 |
| Max. Negotiated Rate |
$35,817.00 |
| Rate for Payer: Adventist Health Commercial |
$9,551.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$32,808.37
|
| Rate for Payer: Cash Price |
$21,490.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$32,330.81
|
| Rate for Payer: Heritage Provider Network Senior |
$32,330.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,643.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,939.00
|
| Rate for Payer: Multiplan Commercial |
$35,817.00
|
|
|
HC PERC PULM ART STENT EA ADD ABN OR NRM
|
Facility
|
IP
|
$15,532.00
|
|
|
Service Code
|
CPT 33904
|
| Hospital Charge Code |
906820327
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,811.29 |
| Max. Negotiated Rate |
$11,649.00 |
| Rate for Payer: Adventist Health Commercial |
$3,106.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,670.48
|
| Rate for Payer: Cash Price |
$6,989.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,515.16
|
| Rate for Payer: Heritage Provider Network Senior |
$10,515.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,811.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,883.00
|
| Rate for Payer: Multiplan Commercial |
$11,649.00
|
|
|
HC PERC PULM ART STENT EA ADD ABN OR NRM
|
Facility
|
OP
|
$15,532.00
|
|
|
Service Code
|
CPT 33904
|
| Hospital Charge Code |
906820327
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$13,202.20 |
| Rate for Payer: Adventist Health Commercial |
$3,106.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,670.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,202.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,542.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,649.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$6,989.40
|
| Rate for Payer: Cash Price |
$6,989.40
|
| Rate for Payer: Cash Price |
$6,989.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,095.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,202.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,202.20
|
| Rate for Payer: Dignity Health Senior |
$13,202.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,614.31
|
| Rate for Payer: Heritage Provider Network Senior |
$9,614.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,486.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,811.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,883.00
|
| Rate for Payer: Multiplan Commercial |
$11,649.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,202.20
|
| Rate for Payer: Vantage Medical Group Senior |
$13,202.20
|
|
