|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
OP
|
$11,239.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,247.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,721.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$5,057.55
|
| Rate for Payer: Cash Price |
$5,057.55
|
| Rate for Payer: Cash Price |
$5,057.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,305.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,608.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7,608.80
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,417.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,034.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,809.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: Multiplan Commercial |
$8,429.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,080.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,754.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
IP
|
$11,239.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,034.26 |
| Max. Negotiated Rate |
$8,429.25 |
| Rate for Payer: Adventist Health Commercial |
$2,247.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,721.19
|
| Rate for Payer: Cash Price |
$5,057.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,608.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7,608.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,034.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,809.75
|
| Rate for Payer: Multiplan Commercial |
$8,429.25
|
|
|
HC REP INT WNDS 7.6-12.5CM
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$691.50 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$633.41
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$624.19
|
| Rate for Payer: Heritage Provider Network Senior |
$624.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.50
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
|
|
HC REP INT WNDS 7.6-12.5CM
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$633.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$599.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: Dignity Health Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$624.19
|
| Rate for Payer: Heritage Provider Network Senior |
$624.19
|
| Rate for Payer: Humana Medicare |
$784.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$444.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.73
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$334.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$308.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
OP
|
$1,323.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$264.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$908.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$595.35
|
| Rate for Payer: Cash Price |
$595.35
|
| Rate for Payer: Cash Price |
$595.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$859.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$895.67
|
| Rate for Payer: Heritage Provider Network Senior |
$895.67
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$637.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$992.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$480.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$442.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
IP
|
$1,323.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.46 |
| Max. Negotiated Rate |
$992.25 |
| Rate for Payer: Adventist Health Commercial |
$264.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$908.90
|
| Rate for Payer: Cash Price |
$595.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$895.67
|
| Rate for Payer: Heritage Provider Network Senior |
$895.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.75
|
| Rate for Payer: Multiplan Commercial |
$992.25
|
|
|
HC REPLACE DUODENAL/JEJUN TUBE
|
Facility
|
IP
|
$4,094.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.01 |
| Max. Negotiated Rate |
$3,070.50 |
| Rate for Payer: Adventist Health Commercial |
$818.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,812.58
|
| Rate for Payer: Cash Price |
$1,842.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,771.64
|
| Rate for Payer: Heritage Provider Network Senior |
$2,771.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.50
|
| Rate for Payer: Multiplan Commercial |
$3,070.50
|
|
|
HC REPLACE DUODENAL/JEJUN TUBE
|
Facility
|
OP
|
$4,094.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.01 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$818.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,812.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,842.30
|
| Rate for Payer: Cash Price |
$1,842.30
|
| Rate for Payer: Cash Price |
$1,842.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,661.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,534.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,057.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,070.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,245.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,245.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
OP
|
$1,845.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$333.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$369.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,267.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$830.25
|
| Rate for Payer: Cash Price |
$830.25
|
| Rate for Payer: Cash Price |
$830.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,199.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,142.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$998.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$1,383.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,245.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,245.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
IP
|
$1,845.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$333.94 |
| Max. Negotiated Rate |
$1,383.75 |
| Rate for Payer: Adventist Health Commercial |
$369.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,267.52
|
| Rate for Payer: Cash Price |
$830.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,249.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,249.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.25
|
| Rate for Payer: Multiplan Commercial |
$1,383.75
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
OP
|
$1,845.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$333.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$369.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,267.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$830.25
|
| Rate for Payer: Cash Price |
$830.25
|
| Rate for Payer: Cash Price |
$830.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,199.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,249.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,249.06
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$889.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$1,383.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$669.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$616.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
IP
|
$1,845.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$333.94 |
| Max. Negotiated Rate |
$1,383.75 |
| Rate for Payer: Adventist Health Commercial |
$369.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,267.52
|
| Rate for Payer: Cash Price |
$830.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,249.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,249.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.25
|
| Rate for Payer: Multiplan Commercial |
$1,383.75
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$2,619.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$474.04 |
| Max. Negotiated Rate |
$1,964.25 |
| Rate for Payer: Adventist Health Commercial |
$523.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,799.25
|
| Rate for Payer: Cash Price |
$1,178.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,773.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,773.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.75
|
| Rate for Payer: Multiplan Commercial |
$1,964.25
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$517.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,775.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,680.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,600.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,291.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$1,938.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$2,619.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$474.04 |
| Max. Negotiated Rate |
$1,964.25 |
| Rate for Payer: Adventist Health Commercial |
$523.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,799.25
|
| Rate for Payer: Cash Price |
$1,178.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,773.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,773.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.75
|
| Rate for Payer: Multiplan Commercial |
$1,964.25
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$467.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$517.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,775.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cash Price |
$1,163.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,680.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,750.04
|
| Rate for Payer: Heritage Provider Network Senior |
$1,750.04
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,245.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$1,938.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$938.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$863.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE PORT THRU SAME ACCESS
|
Facility
|
IP
|
$9,988.00
|
|
|
Service Code
|
CPT 36585
|
| Hospital Charge Code |
909020012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,807.83 |
| Max. Negotiated Rate |
$7,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,997.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,861.76
|
| Rate for Payer: Cash Price |
$4,494.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.88
|
| Rate for Payer: Heritage Provider Network Senior |
$6,761.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,807.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,497.00
|
| Rate for Payer: Multiplan Commercial |
$7,491.00
|
|
|
HC REPLACE PORT THRU SAME ACCESS
|
Facility
|
OP
|
$9,988.00
|
|
|
Service Code
|
CPT 36585
|
| Hospital Charge Code |
909020012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$651.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,997.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,861.76
|
| 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 |
$4,494.60
|
| Rate for Payer: Cash Price |
$4,494.60
|
| Rate for Payer: Cash Price |
$4,494.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,492.20
|
| 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 |
$6,182.57
|
| 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 |
$651.88
|
| 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 |
$1,807.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,497.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$7,491.00
|
| 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 REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
IP
|
$15,041.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,722.42 |
| Max. Negotiated Rate |
$11,280.75 |
| Rate for Payer: Adventist Health Commercial |
$3,008.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,333.17
|
| Rate for Payer: Cash Price |
$6,768.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,182.76
|
| Rate for Payer: Heritage Provider Network Senior |
$10,182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,722.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,760.25
|
| Rate for Payer: Multiplan Commercial |
$11,280.75
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
OP
|
$15,041.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$12,484.56 |
| Rate for Payer: Adventist Health Commercial |
$3,008.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,333.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$6,768.45
|
| Rate for Payer: Cash Price |
$6,768.45
|
| Rate for Payer: Cash Price |
$6,768.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,776.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: Dignity Health Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,776.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,323.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,182.76
|
| Rate for Payer: Heritage Provider Network Senior |
$10,182.76
|
| Rate for Payer: Humana Medicare |
$8,323.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,323.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,249.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,722.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,821.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,760.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,487.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,487.03
|
| Rate for Payer: Multiplan Commercial |
$11,280.75
|
| Rate for Payer: Multiplan WC |
$11,378.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,461.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,025.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
HC REPLACE TUNNELED CV CATH
|
Facility
|
IP
|
$11,698.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
909081841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,117.34 |
| Max. Negotiated Rate |
$8,773.50 |
| Rate for Payer: Adventist Health Commercial |
$2,339.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,036.53
|
| Rate for Payer: Cash Price |
$5,264.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,919.55
|
| Rate for Payer: Heritage Provider Network Senior |
$7,919.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,117.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,924.50
|
| Rate for Payer: Multiplan Commercial |
$8,773.50
|
|
|
HC REPLACE TUNNELED CV CATH
|
Facility
|
OP
|
$11,698.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
909081841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,339.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,036.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$5,264.10
|
| Rate for Payer: Cash Price |
$5,264.10
|
| Rate for Payer: Cash Price |
$5,264.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,603.70
|
| 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 |
$7,241.06
|
| 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 |
$515.24
|
| 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 |
$2,117.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,924.50
|
| 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 |
$8,773.50
|
| 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 REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
OP
|
$10,026.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906820323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,005.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,887.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$4,511.70
|
| Rate for Payer: Cash Price |
$4,511.70
|
| Rate for Payer: Cash Price |
$4,511.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,516.90
|
| 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 |
$6,206.09
|
| 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 |
$515.24
|
| 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 |
$1,814.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,506.50
|
| 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 |
$7,519.50
|
| 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 REPLACE TUNNEL PORT SAME ACCESS
|
Facility
|
IP
|
$10,026.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
906820323
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,814.71 |
| Max. Negotiated Rate |
$7,519.50 |
| Rate for Payer: Adventist Health Commercial |
$2,005.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,887.86
|
| Rate for Payer: Cash Price |
$4,511.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,787.60
|
| Rate for Payer: Heritage Provider Network Senior |
$6,787.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,506.50
|
| Rate for Payer: Multiplan Commercial |
$7,519.50
|
|
|
HC REPLANTATION DIGIT, COMPLETE
|
Facility
|
OP
|
$9,560.00
|
|
|
Service Code
|
CPT 20822
|
| Hospital Charge Code |
900501658
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,912.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,907.03
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,567.72
|
| 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 |
$8,576.00
|
| Rate for Payer: Cash Price |
$4,302.00
|
| Rate for Payer: Cash Price |
$4,302.00
|
| Rate for Payer: Cash Price |
$4,302.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,214.00
|
| 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 |
$6,472.12
|
| Rate for Payer: Heritage Provider Network Senior |
$6,472.12
|
| 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 |
$4,607.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,730.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,390.00
|
| 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 |
$7,170.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,471.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,194.00
|
| 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
|
|
