|
HC INJ FORAMEN EPIDURAL C/T
|
Facility
|
OP
|
$3,673.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
909081855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$664.81 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$734.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,269.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,652.85
|
| Rate for Payer: Cash Price |
$1,652.85
|
| Rate for Payer: Cash Price |
$1,652.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,387.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,203.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,273.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$918.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,754.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| 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 |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJ FORAMEN EPIDURAL L/S
|
Facility
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
909081857
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$720.02 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,561.83
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,693.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,693.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$720.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.50
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
|
|
HC INJ FORAMEN EPIDURAL L/S
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
909081857
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$720.02 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$795.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,458.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Cash Price |
$1,790.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,585.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,386.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,462.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$720.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,983.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| 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 |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJ INTER CRV/THRC WGUID
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
907262321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$520.38 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$575.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,776.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,868.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,725.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,779.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$520.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$718.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,156.25
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| 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 |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC INJ INTER CRV/THRC WGUID
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
907262321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$520.38 |
| Max. Negotiated Rate |
$2,156.25 |
| Rate for Payer: Adventist Health Commercial |
$575.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,851.50
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,946.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,946.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$520.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$718.75
|
| Rate for Payer: Multiplan Commercial |
$2,156.25
|
|
|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$371.41 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Adventist Health Commercial |
$410.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,321.49
|
| Rate for Payer: Cash Price |
$923.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,389.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,389.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.00
|
| Rate for Payer: Multiplan Commercial |
$1,539.00
|
|
|
HC INJ INTER CRV/THRC WO GUID
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
CPT 62320
|
| Hospital Charge Code |
907262320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$371.41 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$410.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,268.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$923.40
|
| Rate for Payer: Cash Price |
$923.40
|
| Rate for Payer: Cash Price |
$923.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,333.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,231.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,270.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$1,539.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| 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 |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
OP
|
$2,875.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$520.38 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$575.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,776.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,868.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,725.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,779.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$520.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$718.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$2,156.25
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| 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 |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC INJ INTER LMBR/SAC W GUID
|
Facility
|
IP
|
$2,875.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
907262323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$520.38 |
| Max. Negotiated Rate |
$2,156.25 |
| Rate for Payer: Adventist Health Commercial |
$575.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,851.50
|
| Rate for Payer: Cash Price |
$1,293.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,946.38
|
| Rate for Payer: Heritage Provider Network Senior |
$1,946.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$520.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$718.75
|
| Rate for Payer: Multiplan Commercial |
$2,156.25
|
|
|
HC INJ INTER LMBR/SAC WO GUID
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$371.41 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Adventist Health Commercial |
$410.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,321.49
|
| Rate for Payer: Cash Price |
$923.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,389.20
|
| Rate for Payer: Heritage Provider Network Senior |
$1,389.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.00
|
| Rate for Payer: Multiplan Commercial |
$1,539.00
|
|
|
HC INJ INTER LMBR/SAC WO GUID
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
907262322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$371.41 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$410.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,268.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$923.40
|
| Rate for Payer: Cash Price |
$923.40
|
| Rate for Payer: Cash Price |
$923.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,333.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,231.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,270.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$1,539.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| 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 |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJ LMBR/SAC INC CATH W GUID
|
Facility
|
IP
|
$4,318.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
907262327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$781.56 |
| Max. Negotiated Rate |
$3,238.50 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,780.79
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,923.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,923.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$781.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
|
|
HC INJ LMBR/SAC INC CATH W GUID
|
Facility
|
OP
|
$4,318.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
907262327
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$781.56 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,668.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,806.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,590.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,672.84
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$781.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| 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 |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJ LMBR/SAC INC CATH WO GUID
|
Facility
|
OP
|
$5,980.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
907262326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,082.38 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,196.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,695.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,691.00
|
| Rate for Payer: Cash Price |
$2,691.00
|
| Rate for Payer: Cash Price |
$2,691.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,887.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,588.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,137.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,701.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,399.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,161.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,082.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,308.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,495.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$4,485.00
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,251.34
|
| Rate for Payer: TriValley Medical Group Senior |
$1,251.34
|
| 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 |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJ LMBR/SAC INC CATH WO GUID
|
Facility
|
IP
|
$5,980.00
|
|
|
Service Code
|
CPT 62326
|
| Hospital Charge Code |
907262326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,082.38 |
| Max. Negotiated Rate |
$4,485.00 |
| Rate for Payer: Adventist Health Commercial |
$1,196.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,851.12
|
| Rate for Payer: Cash Price |
$2,691.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,048.46
|
| Rate for Payer: Heritage Provider Network Senior |
$4,048.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,082.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,495.00
|
| Rate for Payer: Multiplan Commercial |
$4,485.00
|
|
|
HC INJ NRV NRVTG SI JT W/IMAGE
|
Facility
|
IP
|
$1,901.00
|
|
|
Service Code
|
CPT 64451
|
| Hospital Charge Code |
900504451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.08 |
| Max. Negotiated Rate |
$1,425.75 |
| Rate for Payer: Adventist Health Commercial |
$380.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,224.24
|
| Rate for Payer: Cash Price |
$855.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.98
|
| Rate for Payer: Heritage Provider Network Senior |
$1,286.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$344.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.25
|
| Rate for Payer: Multiplan Commercial |
$1,425.75
|
|
|
HC INJ NRV NRVTG SI JT W/IMAGE
|
Facility
|
OP
|
$1,901.00
|
|
|
Service Code
|
CPT 64451
|
| Hospital Charge Code |
900504451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.08 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$380.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,174.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$855.45
|
| Rate for Payer: Cash Price |
$855.45
|
| Rate for Payer: Cash Price |
$855.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,235.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,176.72
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$344.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$1,425.75
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| 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 |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC INJ OF ANESTHETIC/ANTIPASMODE
|
Facility
|
IP
|
$1,406.00
|
|
|
Service Code
|
CPT 72275
|
| Hospital Charge Code |
909001356
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$254.49 |
| Max. Negotiated Rate |
$1,054.50 |
| Rate for Payer: Adventist Health Commercial |
$281.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$905.46
|
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$951.86
|
| Rate for Payer: Heritage Provider Network Senior |
$951.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.50
|
| Rate for Payer: Multiplan Commercial |
$1,054.50
|
|
|
HC INJ OF ANESTHETIC/ANTIPASMODE
|
Facility
|
OP
|
$1,406.00
|
|
|
Service Code
|
CPT 72275
|
| Hospital Charge Code |
909001356
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$254.49 |
| Max. Negotiated Rate |
$1,195.10 |
| Rate for Payer: Adventist Health Commercial |
$281.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$868.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,195.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,054.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$579.33
|
| Rate for Payer: Blue Shield of California Commercial |
$857.66
|
| Rate for Payer: Blue Shield of California EPN |
$686.13
|
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: Cash Price |
$632.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$913.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,195.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,195.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,195.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$829.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$870.31
|
| Rate for Payer: Heritage Provider Network Senior |
$870.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$670.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$984.20
|
| Rate for Payer: Multiplan Commercial |
$1,054.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$703.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$703.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,195.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,195.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,195.10
|
|
|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Adventist Health Commercial |
$98.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.85
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$333.08
|
| Rate for Payer: Heritage Provider Network Senior |
$333.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Multiplan Commercial |
$369.00
|
|
|
HC INJ SCLEROSING SOL SINGLE VEIN
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
909036470
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$98.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$304.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| 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 |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$319.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$304.55
|
| Rate for Payer: Heritage Provider Network Senior |
$643.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$993.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$369.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$575.13
|
| Rate for Payer: TriValley Medical Group Senior |
$575.13
|
| 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 |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC INJ SCLEROSING SOLUTION HEMORR
|
Facility
|
IP
|
$3,183.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$576.12 |
| Max. Negotiated Rate |
$2,387.25 |
| Rate for Payer: Adventist Health Commercial |
$636.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,049.85
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,154.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,154.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.75
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
|
|
HC INJ SCLEROSING SOLUTION HEMORR
|
Facility
|
OP
|
$3,183.00
|
|
|
Service Code
|
CPT 46500
|
| Hospital Charge Code |
900501731
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$576.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$636.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,967.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,511.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,203.17
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,068.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,196.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,154.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,154.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,518.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,375.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,909.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,909.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC INJ SULFUR HEXA LUMASON PER ML
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT Q9950
|
| Hospital Charge Code |
906609950
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$102.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$124.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.23
|
| Rate for Payer: Blue Shield of California Commercial |
$101.26
|
| Rate for Payer: Blue Shield of California EPN |
$81.01
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$107.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$102.75
|
| Rate for Payer: Heritage Provider Network Senior |
$102.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$79.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$116.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$66.40
|
| Rate for Payer: TriValley Medical Group Senior |
$66.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$83.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$83.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.10
|
| Rate for Payer: Vantage Medical Group Senior |
$141.10
|
|
|
HC INJ SULFUR HEXA LUMASON PER ML
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT Q9950
|
| Hospital Charge Code |
906609950
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$106.90
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$112.38
|
| Rate for Payer: Heritage Provider Network Senior |
$112.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
|
