|
HC PERC PULM ART STENT NRM BI
|
Facility
|
OP
|
$31,065.00
|
|
|
Service Code
|
CPT 33901
|
| Hospital Charge Code |
906820325
|
|
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 |
$4,420.00
|
| 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 NRM BI
|
Facility
|
IP
|
$31,065.00
|
|
|
Service Code
|
CPT 33901
|
| Hospital Charge Code |
906820325
|
|
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 NRM UNI
|
Facility
|
IP
|
$31,065.00
|
|
|
Service Code
|
CPT 33900
|
| Hospital Charge Code |
906820324
|
|
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 NRM UNI
|
Facility
|
OP
|
$31,065.00
|
|
|
Service Code
|
CPT 33900
|
| Hospital Charge Code |
906820324
|
|
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 |
$4,420.00
|
| 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 RF ABLATION, LUNG
|
Facility
|
OP
|
$28,379.00
|
|
|
Service Code
|
CPT 32998
|
| Hospital Charge Code |
909081840
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,040.10 |
| Max. Negotiated Rate |
$21,284.25 |
| Rate for Payer: Adventist Health Commercial |
$5,675.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,496.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| 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 |
$12,770.55
|
| Rate for Payer: Cash Price |
$12,770.55
|
| Rate for Payer: Cash Price |
$12,770.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,446.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: Dignity Health Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,209.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,566.60
|
| Rate for Payer: Heritage Provider Network Senior |
$8,867.33
|
| Rate for Payer: Humana Medicare |
$7,209.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,040.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,697.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,136.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,506.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,094.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,083.60
|
| Rate for Payer: Multiplan Commercial |
$21,284.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,930.13
|
| Rate for Payer: TriValley Medical Group Senior |
$7,930.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC PERC RF ABLATION, LUNG
|
Facility
|
IP
|
$28,379.00
|
|
|
Service Code
|
CPT 32998
|
| Hospital Charge Code |
909081840
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,136.60 |
| Max. Negotiated Rate |
$21,284.25 |
| Rate for Payer: Adventist Health Commercial |
$5,675.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,496.37
|
| Rate for Payer: Cash Price |
$12,770.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,212.58
|
| Rate for Payer: Heritage Provider Network Senior |
$19,212.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,136.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,094.75
|
| Rate for Payer: Multiplan Commercial |
$21,284.25
|
|
|
HC PERC RF ABLATION, RENAL TUMOR
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
909081854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,161.32 |
| Max. Negotiated Rate |
$13,697.50 |
| Rate for Payer: Adventist Health Commercial |
$2,388.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,203.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$5,373.45
|
| Rate for Payer: Cash Price |
$5,373.45
|
| Rate for Payer: Cash Price |
$5,373.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,761.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: Dignity Health Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,209.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,391.48
|
| Rate for Payer: Heritage Provider Network Senior |
$8,867.33
|
| Rate for Payer: Humana Medicare |
$7,209.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,209.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,697.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,161.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,506.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,985.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,083.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,083.60
|
| Rate for Payer: Multiplan Commercial |
$8,955.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,930.13
|
| Rate for Payer: TriValley Medical Group Senior |
$7,930.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC PERC RF ABLATION, RENAL TUMOR
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
909081854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,161.32 |
| Max. Negotiated Rate |
$8,955.75 |
| Rate for Payer: Adventist Health Commercial |
$2,388.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,203.47
|
| Rate for Payer: Cash Price |
$5,373.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,084.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8,084.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,161.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,985.25
|
| Rate for Payer: Multiplan Commercial |
$8,955.75
|
|
|
HC PERC SKEL FIX OF FEM FRAC
|
Facility
|
IP
|
$8,833.00
|
|
|
Service Code
|
CPT 27509
|
| Hospital Charge Code |
900501086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,598.77 |
| Max. Negotiated Rate |
$6,624.75 |
| Rate for Payer: Adventist Health Commercial |
$1,766.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,068.27
|
| Rate for Payer: Blue Shield of California Commercial |
$3,727.53
|
| Rate for Payer: Blue Shield of California EPN |
$3,550.87
|
| Rate for Payer: Cash Price |
$3,974.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,979.94
|
| Rate for Payer: Heritage Provider Network Senior |
$5,979.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,598.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,208.25
|
| Rate for Payer: Multiplan Commercial |
$6,624.75
|
|
|
HC PERC SKEL FIX OF FEM FRAC
|
Facility
|
OP
|
$8,833.00
|
|
|
Service Code
|
CPT 27509
|
| Hospital Charge Code |
900501086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,407.80 |
| Rate for Payer: Adventist Health Commercial |
$1,766.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,068.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$3,974.85
|
| Rate for Payer: Cash Price |
$3,974.85
|
| Rate for Payer: Cash Price |
$3,974.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,741.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,979.94
|
| Rate for Payer: Heritage Provider Network Senior |
$5,979.94
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,257.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,598.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,208.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$6,624.75
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,207.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,951.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC PERC SKEL FIX OF FEM FRAC PROX
|
Facility
|
IP
|
$10,672.00
|
|
|
Service Code
|
CPT 27235
|
| Hospital Charge Code |
900501082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,931.63 |
| Max. Negotiated Rate |
$8,004.00 |
| Rate for Payer: Adventist Health Commercial |
$2,134.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,331.66
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,224.94
|
| Rate for Payer: Heritage Provider Network Senior |
$7,224.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,931.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,668.00
|
| Rate for Payer: Multiplan Commercial |
$8,004.00
|
|
|
HC PERC SKEL FIX OF FEM FRAC PROX
|
Facility
|
OP
|
$10,672.00
|
|
|
Service Code
|
CPT 27235
|
| Hospital Charge Code |
900501082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,407.80 |
| Rate for Payer: Adventist Health Commercial |
$2,134.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,331.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,936.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,224.94
|
| Rate for Payer: Heritage Provider Network Senior |
$7,224.94
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,143.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,931.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,668.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$8,004.00
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,875.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,565.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC PERC THROMB DIALYSIS CRCT
|
Facility
|
OP
|
$12,694.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
909036904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,297.61 |
| Max. Negotiated Rate |
$14,131.19 |
| Rate for Payer: Adventist Health Commercial |
$2,538.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,720.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$5,712.30
|
| Rate for Payer: Cash Price |
$5,712.30
|
| Rate for Payer: Cash Price |
$5,712.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,251.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: Dignity Health Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,141.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,857.59
|
| Rate for Payer: Heritage Provider Network Senior |
$8,783.86
|
| Rate for Payer: Humana Medicare |
$7,141.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,525.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,568.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,297.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,426.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,173.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,998.10
|
| Rate for Payer: Multiplan Commercial |
$9,520.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,855.48
|
| Rate for Payer: TriValley Medical Group Senior |
$7,855.48
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC PERC THROMB DIALYSIS CRCT
|
Facility
|
IP
|
$12,694.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
909036904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,297.61 |
| Max. Negotiated Rate |
$9,520.50 |
| Rate for Payer: Adventist Health Commercial |
$2,538.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,720.78
|
| Rate for Payer: Cash Price |
$5,712.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,593.84
|
| Rate for Payer: Heritage Provider Network Senior |
$8,593.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,297.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,173.50
|
| Rate for Payer: Multiplan Commercial |
$9,520.50
|
|
|
HC PERCT PLCMNT DUODENAL/JEJUNOST
|
Facility
|
IP
|
$5,636.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
909020003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,020.12 |
| Max. Negotiated Rate |
$4,227.00 |
| Rate for Payer: Adventist Health Commercial |
$1,127.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,871.93
|
| Rate for Payer: Cash Price |
$2,536.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,815.57
|
| Rate for Payer: Heritage Provider Network Senior |
$3,815.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,020.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,409.00
|
| Rate for Payer: Multiplan Commercial |
$4,227.00
|
|
|
HC PERCT PLCMNT DUODENAL/JEJUNOST
|
Facility
|
OP
|
$5,636.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
909020003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,020.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,127.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,871.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| 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 |
$2,536.20
|
| Rate for Payer: Cash Price |
$2,536.20
|
| Rate for Payer: Cash Price |
$2,536.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,663.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: Dignity Health Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,377.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,488.68
|
| Rate for Payer: Heritage Provider Network Senior |
$2,924.26
|
| Rate for Payer: Humana Medicare |
$2,377.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,706.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,517.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,020.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,805.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,409.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,995.59
|
| Rate for Payer: Multiplan Commercial |
$4,227.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,615.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,615.20
|
| 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 |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC PERC TRANSPORTAL W HEMO
|
Facility
|
IP
|
$9,032.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
909081690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,634.79 |
| Max. Negotiated Rate |
$6,774.00 |
| Rate for Payer: Adventist Health Commercial |
$1,806.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,204.98
|
| Rate for Payer: Cash Price |
$4,064.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,114.66
|
| Rate for Payer: Heritage Provider Network Senior |
$6,114.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,634.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,258.00
|
| Rate for Payer: Multiplan Commercial |
$6,774.00
|
|
|
HC PERC TRANSPORTAL W HEMO
|
Facility
|
OP
|
$9,032.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
909081690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$1,806.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$341.91
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,204.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$4,064.40
|
| Rate for Payer: Cash Price |
$4,064.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,870.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,870.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,590.81
|
| Rate for Payer: Heritage Provider Network Senior |
$5,590.81
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$192.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,634.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,258.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,774.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC PERC TRANSPORTAL W/O HEMO
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
909081691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$347.19 |
| Max. Negotiated Rate |
$7,566.84 |
| Rate for Payer: Adventist Health Commercial |
$927.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$347.19
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,186.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.48
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,015.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,015.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,871.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,871.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,159.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$3,479.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,982.55
|
| Rate for Payer: TriValley Medical Group Senior |
$3,982.55
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,055.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,055.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC PERC TRANSPORTAL W/O HEMO
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
909081691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$839.66 |
| Max. Negotiated Rate |
$3,479.25 |
| Rate for Payer: Adventist Health Commercial |
$927.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,186.99
|
| Rate for Payer: Cash Price |
$2,087.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,140.60
|
| Rate for Payer: Heritage Provider Network Senior |
$3,140.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,159.75
|
| Rate for Payer: Multiplan Commercial |
$3,479.25
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
OP
|
$26,589.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
906820290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.68 |
| Max. Negotiated Rate |
$22,600.65 |
| Rate for Payer: Adventist Health Commercial |
$5,317.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,266.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,600.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,623.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,941.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| 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 |
$11,965.05
|
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,282.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,600.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,600.65
|
| Rate for Payer: Dignity Health Senior |
$22,600.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,458.59
|
| Rate for Payer: Heritage Provider Network Senior |
$16,458.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$148.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,815.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,812.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,647.25
|
| Rate for Payer: Multiplan Commercial |
$19,941.75
|
| 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 Medi-Cal |
$22,600.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22,600.65
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
IP
|
$26,589.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
906820290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,812.61 |
| Max. Negotiated Rate |
$19,941.75 |
| Rate for Payer: Adventist Health Commercial |
$5,317.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,266.64
|
| Rate for Payer: Cash Price |
$11,965.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,000.75
|
| Rate for Payer: Heritage Provider Network Senior |
$18,000.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,812.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,647.25
|
| Rate for Payer: Multiplan Commercial |
$19,941.75
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
IP
|
$11,974.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
906811715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,167.29 |
| Max. Negotiated Rate |
$8,980.50 |
| Rate for Payer: Adventist Health Commercial |
$2,394.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,226.14
|
| Rate for Payer: Cash Price |
$5,388.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,106.40
|
| Rate for Payer: Heritage Provider Network Senior |
$8,106.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,167.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,993.50
|
| Rate for Payer: Multiplan Commercial |
$8,980.50
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
IP
|
$14,328.00
|
|
|
Service Code
|
CPT 0715T
|
| Hospital Charge Code |
906820294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,593.37 |
| Max. Negotiated Rate |
$10,746.00 |
| Rate for Payer: Adventist Health Commercial |
$2,865.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,843.34
|
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,700.06
|
| Rate for Payer: Heritage Provider Network Senior |
$9,700.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,593.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,582.00
|
| Rate for Payer: Multiplan Commercial |
$10,746.00
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
OP
|
$14,328.00
|
|
|
Service Code
|
CPT 0715T
|
| Hospital Charge Code |
906820294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$2,865.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,843.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,178.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,880.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,746.00
|
| 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 |
$6,447.60
|
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Cash Price |
$6,447.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,313.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,178.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,178.80
|
| Rate for Payer: Dignity Health Senior |
$12,178.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,869.03
|
| Rate for Payer: Heritage Provider Network Senior |
$8,869.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,906.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,593.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,582.00
|
| Rate for Payer: Multiplan Commercial |
$10,746.00
|
| 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 |
$12,178.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,178.80
|
|
