|
HC INTRA-ART INJ OR INFUS
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 96379
|
| Hospital Charge Code |
911896379
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$60.23 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$518.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$419.67
|
| Rate for Payer: Blue Shield of California Commercial |
$638.00
|
| Rate for Payer: Blue Shield of California EPN |
$512.00
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$545.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.01
|
| Rate for Payer: EPIC Health Plan Medicare |
$60.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$519.34
|
| Rate for Payer: Heritage Provider Network Senior |
$519.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$400.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$629.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$66.25
|
| Rate for Payer: TriValley Medical Group Senior |
$60.23
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$626.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$526.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
IP
|
$31,046.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,619.33 |
| Max. Negotiated Rate |
$23,284.50 |
| Rate for Payer: Adventist Health Commercial |
$6,209.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,993.62
|
| Rate for Payer: Cash Price |
$13,970.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,018.14
|
| Rate for Payer: Heritage Provider Network Senior |
$21,018.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,619.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,761.50
|
| Rate for Payer: Multiplan Commercial |
$23,284.50
|
|
|
HC INTRACARDIAC SHUNT STENT
|
Facility
|
OP
|
$31,046.00
|
|
|
Service Code
|
CPT 33745
|
| Hospital Charge Code |
906811745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$26,389.10 |
| Rate for Payer: Adventist Health Commercial |
$6,209.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,186.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,389.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,075.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,284.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| 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 |
$13,970.70
|
| Rate for Payer: Cash Price |
$13,970.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20,179.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,389.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,389.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,389.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,217.47
|
| Rate for Payer: Heritage Provider Network Senior |
$19,217.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,808.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,619.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,761.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,732.20
|
| Rate for Payer: Multiplan Commercial |
$23,284.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,389.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,389.10
|
| Rate for Payer: Vantage Medical Group Senior |
$26,389.10
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
IP
|
$31,046.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906811746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,619.33 |
| Max. Negotiated Rate |
$23,284.50 |
| Rate for Payer: Adventist Health Commercial |
$6,209.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,993.62
|
| Rate for Payer: Cash Price |
$13,970.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,018.14
|
| Rate for Payer: Heritage Provider Network Senior |
$21,018.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,619.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,761.50
|
| Rate for Payer: Multiplan Commercial |
$23,284.50
|
|
|
HC INTRACARDIAC SHUNT STENT ADDL
|
Facility
|
OP
|
$31,046.00
|
|
|
Service Code
|
CPT 33746
|
| Hospital Charge Code |
906811746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$26,389.10 |
| Rate for Payer: Adventist Health Commercial |
$6,209.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,186.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,389.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,075.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,284.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,185.00
|
| 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 |
$13,970.70
|
| Rate for Payer: Cash Price |
$13,970.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$20,179.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,389.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,389.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26,389.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,217.47
|
| Rate for Payer: Heritage Provider Network Senior |
$19,217.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$14,808.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,619.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,761.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21,732.20
|
| Rate for Payer: Multiplan Commercial |
$23,284.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,389.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,389.10
|
| Rate for Payer: Vantage Medical Group Senior |
$26,389.10
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$250.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$773.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$688.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$938.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$562.95
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$813.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,063.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,063.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$774.37
|
| Rate for Payer: Heritage Provider Network Senior |
$774.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$596.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$875.70
|
| Rate for Payer: Multiplan Commercial |
$938.25
|
| 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 |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,063.35
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.43 |
| Max. Negotiated Rate |
$938.25 |
| Rate for Payer: Adventist Health Commercial |
$250.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$805.64
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$846.93
|
| Rate for Payer: Heritage Provider Network Senior |
$846.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$226.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.75
|
| Rate for Payer: Multiplan Commercial |
$938.25
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
|
IP
|
$22,357.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,046.62 |
| Max. Negotiated Rate |
$16,767.75 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,397.91
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$15,135.69
|
| Rate for Payer: Heritage Provider Network Senior |
$15,135.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,046.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,589.25
|
| Rate for Payer: Multiplan Commercial |
$16,767.75
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
|
OP
|
$22,357.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$19,003.45 |
| Rate for Payer: Adventist Health Commercial |
$4,471.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,816.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,003.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,296.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,767.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$10,060.65
|
| Rate for Payer: Cash Price |
$10,060.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$14,532.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,003.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,003.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,003.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,414.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,838.98
|
| Rate for Payer: Heritage Provider Network Senior |
$13,838.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10,664.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,046.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,589.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,649.90
|
| Rate for Payer: Multiplan Commercial |
$16,767.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,003.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,003.45
|
| Rate for Payer: Vantage Medical Group Senior |
$19,003.45
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
IP
|
$7,102.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,285.46 |
| Max. Negotiated Rate |
$5,326.50 |
| Rate for Payer: Adventist Health Commercial |
$1,420.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,573.69
|
| Rate for Payer: Cash Price |
$3,195.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,808.05
|
| Rate for Payer: Heritage Provider Network Senior |
$4,808.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,285.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,775.50
|
| Rate for Payer: Multiplan Commercial |
$5,326.50
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
OP
|
$7,102.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,285.46 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,420.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,389.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,036.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,906.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,326.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$3,195.90
|
| Rate for Payer: Cash Price |
$3,195.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,616.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,036.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,036.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,036.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,261.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,396.14
|
| Rate for Payer: Heritage Provider Network Senior |
$4,396.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,387.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,285.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,775.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,971.40
|
| Rate for Payer: Multiplan Commercial |
$5,326.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,036.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,036.70
|
| Rate for Payer: Vantage Medical Group Senior |
$6,036.70
|
|
|
HC INTRANASAL BX
|
Facility
|
OP
|
$3,627.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$656.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,241.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| 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 |
$1,632.15
|
| Rate for Payer: Cash Price |
$1,632.15
|
| Rate for Payer: Cash Price |
$1,632.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,357.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,995.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,245.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,454.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,791.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$656.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,294.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$2,720.25
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,195.16
|
| Rate for Payer: TriValley Medical Group Senior |
$2,195.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC INTRANASAL BX
|
Facility
|
IP
|
$3,627.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$656.49 |
| Max. Negotiated Rate |
$2,720.25 |
| Rate for Payer: Adventist Health Commercial |
$725.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,335.79
|
| Rate for Payer: Cash Price |
$1,632.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,455.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,455.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$656.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.75
|
| Rate for Payer: Multiplan Commercial |
$2,720.25
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
IP
|
$5,323.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$963.46 |
| Max. Negotiated Rate |
$3,992.25 |
| Rate for Payer: Adventist Health Commercial |
$1,064.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,428.01
|
| Rate for Payer: Cash Price |
$2,395.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,603.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3,603.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$963.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,330.75
|
| Rate for Payer: Multiplan Commercial |
$3,992.25
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
OP
|
$5,323.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$963.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,064.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,289.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,528.43
|
| Rate for Payer: Blue Shield of California EPN |
$2,012.09
|
| Rate for Payer: Cash Price |
$2,395.35
|
| Rate for Payer: Cash Price |
$2,395.35
|
| Rate for Payer: Cash Price |
$2,395.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,459.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,264.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,603.67
|
| Rate for Payer: Heritage Provider Network Senior |
$3,603.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,539.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$963.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,330.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$3,992.25
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,193.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,193.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
IP
|
$5,741.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,039.12 |
| Max. Negotiated Rate |
$4,305.75 |
| Rate for Payer: Adventist Health Commercial |
$1,148.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,697.20
|
| Rate for Payer: Cash Price |
$2,583.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,886.66
|
| Rate for Payer: Heritage Provider Network Senior |
$3,886.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,039.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,435.25
|
| Rate for Payer: Multiplan Commercial |
$4,305.75
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
OP
|
$5,741.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,039.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,148.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,547.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,726.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,170.10
|
| Rate for Payer: Cash Price |
$2,583.45
|
| Rate for Payer: Cash Price |
$2,583.45
|
| Rate for Payer: Cash Price |
$2,583.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,731.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,995.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,886.66
|
| Rate for Payer: Heritage Provider Network Senior |
$3,886.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,738.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,039.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,294.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,435.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$4,305.75
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,444.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3,444.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
IP
|
$4,104.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$742.82 |
| Max. Negotiated Rate |
$3,078.00 |
| Rate for Payer: Adventist Health Commercial |
$820.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,642.98
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,778.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,778.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$742.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,026.00
|
| Rate for Payer: Multiplan Commercial |
$3,078.00
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
OP
|
$4,104.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$820.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,536.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,949.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,551.31
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,846.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,667.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,778.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,957.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$742.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,026.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$3,078.00
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,462.40
|
| Rate for Payer: TriValley Medical Group Senior |
$2,462.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
IP
|
$988.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.83 |
| Max. Negotiated Rate |
$741.00 |
| Rate for Payer: Adventist Health Commercial |
$197.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$636.27
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.88
|
| Rate for Payer: Heritage Provider Network Senior |
$668.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.00
|
| Rate for Payer: Multiplan Commercial |
$741.00
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
OP
|
$988.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.83 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$197.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$610.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$469.30
|
| Rate for Payer: Blue Shield of California EPN |
$373.46
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$642.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$574.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.88
|
| Rate for Payer: Heritage Provider Network Senior |
$668.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$471.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$178.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$741.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$592.80
|
| Rate for Payer: TriValley Medical Group Senior |
$592.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC INTRAVASC LITHO FEM AND POP VASC SAME ARTERY
|
Facility
|
OP
|
$17,682.00
|
|
|
Service Code
|
CPT 37279
|
| Hospital Charge Code |
906811845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,200.44 |
| Max. Negotiated Rate |
$15,029.70 |
| Rate for Payer: Adventist Health Commercial |
$3,536.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,927.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,029.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,725.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,261.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,844.54
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,956.90
|
| Rate for Payer: Cash Price |
$7,956.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,493.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,029.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,029.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,029.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,945.16
|
| Rate for Payer: Heritage Provider Network Senior |
$10,945.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8,434.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,200.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,420.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,377.40
|
| Rate for Payer: Multiplan Commercial |
$13,261.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8,841.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,029.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,029.70
|
| Rate for Payer: Vantage Medical Group Senior |
$15,029.70
|
|
|
HC INTRAVASC LITHO FEM AND POP VASC SAME ARTERY
|
Facility
|
IP
|
$17,682.00
|
|
|
Service Code
|
CPT 37279
|
| Hospital Charge Code |
906811845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,200.44 |
| Max. Negotiated Rate |
$13,261.50 |
| Rate for Payer: Adventist Health Commercial |
$3,536.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,387.21
|
| Rate for Payer: Cash Price |
$7,956.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,970.71
|
| Rate for Payer: Heritage Provider Network Senior |
$11,970.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,200.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,420.50
|
| Rate for Payer: Multiplan Commercial |
$13,261.50
|
|
|
HC INTRAVASC LITHO IVT SAME ARTERY
|
Facility
|
OP
|
$11,138.00
|
|
|
Service Code
|
CPT 37262
|
| Hospital Charge Code |
906811828
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,015.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,227.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,883.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,467.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,125.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,353.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,571.23
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$5,012.10
|
| Rate for Payer: Cash Price |
$5,012.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,239.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,467.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,467.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,467.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,894.42
|
| Rate for Payer: Heritage Provider Network Senior |
$6,894.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,312.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,015.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,784.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,796.60
|
| Rate for Payer: Multiplan Commercial |
$8,353.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,569.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,569.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,467.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,467.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,467.30
|
|
|
HC INTRAVASC LITHO IVT SAME ARTERY
|
Facility
|
IP
|
$11,138.00
|
|
|
Service Code
|
CPT 37262
|
| Hospital Charge Code |
906811828
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,015.98 |
| Max. Negotiated Rate |
$8,353.50 |
| Rate for Payer: Adventist Health Commercial |
$2,227.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,172.87
|
| Rate for Payer: Cash Price |
$5,012.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,540.43
|
| Rate for Payer: Heritage Provider Network Senior |
$7,540.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,015.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,784.50
|
| Rate for Payer: Multiplan Commercial |
$8,353.50
|
|
