|
HC REDUCING SUBSTANCE
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.14
|
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.25
|
| Rate for Payer: Heritage Provider Network Senior |
$60.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.25
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
IP
|
$1,224.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.54 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Adventist Health Commercial |
$244.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$840.89
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$828.65
|
| Rate for Payer: Heritage Provider Network Senior |
$828.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$918.00
|
|
|
HC REDUCTION/DISLOC KNUCKLE JOINT
|
Facility
|
OP
|
$1,224.00
|
|
|
Service Code
|
CPT 26705
|
| Hospital Charge Code |
900501633
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.54 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$244.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$840.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$795.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$828.65
|
| Rate for Payer: Heritage Provider Network Senior |
$828.65
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$589.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$918.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$444.43
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$408.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.82 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Adventist Health Commercial |
$220.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$758.45
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$747.41
|
| Rate for Payer: Heritage Provider Network Senior |
$747.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
|
|
HC REDUCTION OF INTUSSUSCEPTION
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
909001805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.33 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Adventist Health Commercial |
$220.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$192.71
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$758.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.84
|
| Rate for Payer: Blue Shield of California Commercial |
$525.60
|
| Rate for Payer: Blue Shield of California EPN |
$298.89
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$717.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: Dignity Health Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$717.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$229.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$683.38
|
| Rate for Payer: Heritage Provider Network Senior |
$683.38
|
| Rate for Payer: Humana Medicare |
$229.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$436.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$270.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$229.56
|
| Rate for Payer: TriValley Medical Group Senior |
$229.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$137.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$478.50 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$431.93
|
| Rate for Payer: Heritage Provider Network Senior |
$431.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
|
|
HC REFILL/MAIN IMPL PUMP/RESV
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 95990
|
| Hospital Charge Code |
911801003
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$77.25 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$438.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$530.00
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$414.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: Dignity Health Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$423.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$394.92
|
| Rate for Payer: Heritage Provider Network Senior |
$394.92
|
| Rate for Payer: Humana Medicare |
$423.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$803.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$533.16
|
| Rate for Payer: Multiplan Commercial |
$478.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$465.45
|
| Rate for Payer: TriValley Medical Group Senior |
$423.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$727.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$610.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
IP
|
$10,169.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,840.59 |
| Max. Negotiated Rate |
$7,626.75 |
| Rate for Payer: Adventist Health Commercial |
$2,033.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,986.10
|
| Rate for Payer: Cash Price |
$4,576.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,884.41
|
| Rate for Payer: Heritage Provider Network Senior |
$6,884.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,840.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,542.25
|
| Rate for Payer: Multiplan Commercial |
$7,626.75
|
|
|
HC RELEASE OF EYE FLUID
|
Facility
|
OP
|
$10,169.00
|
|
|
Service Code
|
CPT 67015
|
| Hospital Charge Code |
900501531
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$7,626.75 |
| Rate for Payer: Adventist Health Commercial |
$2,033.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,986.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$4,576.05
|
| Rate for Payer: Cash Price |
$4,576.05
|
| Rate for Payer: Cash Price |
$4,576.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,609.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,609.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,884.41
|
| Rate for Payer: Heritage Provider Network Senior |
$6,884.41
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,901.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,840.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,542.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: Multiplan Commercial |
$7,626.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,692.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,397.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
OP
|
$7,212.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820316
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$8,689.75 |
| Rate for Payer: Adventist Health Commercial |
$1,442.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,854.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,954.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,687.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: Dignity Health Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,687.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$195.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,464.23
|
| Rate for Payer: Heritage Provider Network Senior |
$240.06
|
| Rate for Payer: Humana Medicare |
$195.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$370.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,305.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,803.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.91
|
| Rate for Payer: Multiplan Commercial |
$5,409.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$214.69
|
| Rate for Payer: TriValley Medical Group Senior |
$195.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$547.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC REMOVAL LV LEAD PACE OR ICD
|
Facility
|
IP
|
$7,212.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820316
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,305.37 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,442.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,954.64
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Cash Price |
$3,245.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,305.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,803.00
|
| Rate for Payer: Multiplan Commercial |
$5,409.00
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
OP
|
$11,377.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,275.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,816.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$5,119.65
|
| Rate for Payer: Cash Price |
$5,119.65
|
| Rate for Payer: Cash Price |
$5,119.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,395.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: Dignity Health Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,762.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,702.23
|
| Rate for Payer: Heritage Provider Network Senior |
$7,702.23
|
| Rate for Payer: Humana Medicare |
$4,762.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,483.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,059.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,619.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,844.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,000.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,000.76
|
| Rate for Payer: Multiplan Commercial |
$8,532.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,130.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,801.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC REMOVAL OF BREAST IMPLANT
|
Facility
|
IP
|
$11,377.00
|
|
|
Service Code
|
CPT 19328
|
| Hospital Charge Code |
900501758
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,059.24 |
| Max. Negotiated Rate |
$8,532.75 |
| Rate for Payer: Adventist Health Commercial |
$2,275.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,816.00
|
| Rate for Payer: Cash Price |
$5,119.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,702.23
|
| Rate for Payer: Heritage Provider Network Senior |
$7,702.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,059.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,844.25
|
| Rate for Payer: Multiplan Commercial |
$8,532.75
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$21,487.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906820321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$41.93 |
| Max. Negotiated Rate |
$18,263.95 |
| Rate for Payer: Adventist Health Commercial |
$4,297.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,761.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,263.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,817.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,115.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$9,669.15
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,966.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,263.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,263.95
|
| Rate for Payer: Dignity Health Senior |
$18,263.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,300.45
|
| Rate for Payer: Heritage Provider Network Senior |
$13,300.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,356.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,889.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,371.75
|
| Rate for Payer: Multiplan Commercial |
$16,115.25
|
| 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 |
$18,263.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18,263.95
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
OP
|
$18,226.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906811997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$41.93 |
| Max. Negotiated Rate |
$15,492.10 |
| Rate for Payer: Adventist Health Commercial |
$3,645.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,521.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,492.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,024.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,669.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| 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 |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,846.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,492.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,492.10
|
| Rate for Payer: Dignity Health Senior |
$15,492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,281.89
|
| Rate for Payer: Heritage Provider Network Senior |
$11,281.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,784.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,298.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,556.50
|
| Rate for Payer: Multiplan Commercial |
$13,669.50
|
| 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 |
$15,492.10
|
| Rate for Payer: Vantage Medical Group Senior |
$15,492.10
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$21,487.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906820321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,889.15 |
| Max. Negotiated Rate |
$16,115.25 |
| Rate for Payer: Adventist Health Commercial |
$4,297.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,761.57
|
| Rate for Payer: Cash Price |
$9,669.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,546.70
|
| Rate for Payer: Heritage Provider Network Senior |
$14,546.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,889.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,371.75
|
| Rate for Payer: Multiplan Commercial |
$16,115.25
|
|
|
HC REMOVAL PERC VAD RIGHT VENOUS
|
Facility
|
IP
|
$18,226.00
|
|
|
Service Code
|
CPT 33997
|
| Hospital Charge Code |
906811997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,298.91 |
| Max. Negotiated Rate |
$13,669.50 |
| Rate for Payer: Adventist Health Commercial |
$3,645.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,521.26
|
| Rate for Payer: Cash Price |
$8,201.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,339.00
|
| Rate for Payer: Heritage Provider Network Senior |
$12,339.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,298.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,556.50
|
| Rate for Payer: Multiplan Commercial |
$13,669.50
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
IP
|
$9,896.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,791.18 |
| Max. Negotiated Rate |
$7,422.00 |
| Rate for Payer: Adventist Health Commercial |
$1,979.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,798.55
|
| Rate for Payer: Cash Price |
$4,453.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,699.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6,699.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,474.00
|
| Rate for Payer: Multiplan Commercial |
$7,422.00
|
|
|
HC REMOVE BLOOD CLOT FROM EYE
|
Facility
|
OP
|
$9,896.00
|
|
|
Service Code
|
CPT 65930
|
| Hospital Charge Code |
900501635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$7,422.00 |
| Rate for Payer: Adventist Health Commercial |
$1,979.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,798.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$4,453.20
|
| Rate for Payer: Cash Price |
$4,453.20
|
| Rate for Payer: Cash Price |
$4,453.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,432.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: Dignity Health Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,432.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,911.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,699.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6,699.59
|
| Rate for Payer: Humana Medicare |
$2,911.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,769.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,435.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,474.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,668.65
|
| Rate for Payer: Multiplan Commercial |
$7,422.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,593.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,306.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC REMOVE FIBRIN SHEATH
|
Facility
|
OP
|
$7,683.00
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
909020014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,135.73 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,536.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,278.22
|
| 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 |
$4,547.00
|
| 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 |
$3,457.35
|
| Rate for Payer: Cash Price |
$3,457.35
|
| Rate for Payer: Cash Price |
$3,457.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,993.95
|
| 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 |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,755.78
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,135.73
|
| 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 |
$1,390.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,920.75
|
| 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 |
$5,762.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| 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 |
$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 REMOVE FIBRIN SHEATH
|
Facility
|
IP
|
$7,683.00
|
|
|
Service Code
|
CPT 36595
|
| Hospital Charge Code |
909020014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,390.62 |
| Max. Negotiated Rate |
$5,762.25 |
| Rate for Payer: Adventist Health Commercial |
$1,536.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,278.22
|
| Rate for Payer: Cash Price |
$3,457.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,201.39
|
| Rate for Payer: Heritage Provider Network Senior |
$5,201.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,390.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,920.75
|
| Rate for Payer: Multiplan Commercial |
$5,762.25
|
|
|
HC REMOVE FOREIGN BODY (RENAL)
|
Facility
|
IP
|
$10,024.00
|
|
|
Service Code
|
CPT 50561
|
| Hospital Charge Code |
909081362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,814.34 |
| Max. Negotiated Rate |
$7,518.00 |
| Rate for Payer: Adventist Health Commercial |
$2,004.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,886.49
|
| Rate for Payer: Cash Price |
$4,510.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,786.25
|
| Rate for Payer: Heritage Provider Network Senior |
$6,786.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,506.00
|
| Rate for Payer: Multiplan Commercial |
$7,518.00
|
|
|
HC REMOVE FOREIGN BODY (RENAL)
|
Facility
|
OP
|
$10,024.00
|
|
|
Service Code
|
CPT 50561
|
| Hospital Charge Code |
909081362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$658.62 |
| Max. Negotiated Rate |
$12,283.52 |
| Rate for Payer: Adventist Health Commercial |
$2,004.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,886.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$4,510.80
|
| Rate for Payer: Cash Price |
$4,510.80
|
| Rate for Payer: Cash Price |
$4,510.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,515.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: Dignity Health Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,465.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,204.86
|
| Rate for Payer: Heritage Provider Network Senior |
$7,951.96
|
| Rate for Payer: Humana Medicare |
$6,465.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$658.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,465.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,283.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,628.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,506.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,145.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,145.91
|
| Rate for Payer: Multiplan Commercial |
$7,518.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,111.51
|
| Rate for Payer: TriValley Medical Group Senior |
$7,111.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC REMOVE FOREIGN BODY (URETER
|
Facility
|
OP
|
$10,024.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
909081363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$778.83 |
| Max. Negotiated Rate |
$12,283.52 |
| Rate for Payer: Adventist Health Commercial |
$2,004.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,886.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,465.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| 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 |
$4,510.80
|
| Rate for Payer: Cash Price |
$4,510.80
|
| Rate for Payer: Cash Price |
$4,510.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,515.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,111.51
|
| Rate for Payer: Dignity Health Senior |
$6,465.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,465.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,204.86
|
| Rate for Payer: Heritage Provider Network Senior |
$7,951.96
|
| Rate for Payer: Humana Medicare |
$6,465.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,465.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,283.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,628.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,506.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,145.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,145.91
|
| Rate for Payer: Multiplan Commercial |
$7,518.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,111.51
|
| Rate for Payer: TriValley Medical Group Senior |
$7,111.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,096.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,697.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,111.51
|
| Rate for Payer: Vantage Medical Group Senior |
$6,465.01
|
|
|
HC REMOVE FOREIGN BODY (URETER
|
Facility
|
IP
|
$10,024.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
909081363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,814.34 |
| Max. Negotiated Rate |
$7,518.00 |
| Rate for Payer: Adventist Health Commercial |
$2,004.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,886.49
|
| Rate for Payer: Cash Price |
$4,510.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,786.25
|
| Rate for Payer: Heritage Provider Network Senior |
$6,786.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,506.00
|
| Rate for Payer: Multiplan Commercial |
$7,518.00
|
|
