|
HC PENILE INJECTION
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$258.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$690.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$886.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$710.05
|
| Rate for Payer: Cash Price |
$710.05
|
| Rate for Payer: Cash Price |
$710.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$839.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Senior |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$309.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.01
|
| Rate for Payer: Heritage Provider Network Senior |
$874.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$615.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$389.37
|
| Rate for Payer: Multiplan Commercial |
$968.25
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$464.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$427.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC PENILE INJECTION
|
Facility
|
IP
|
$1,291.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$233.67 |
| Max. Negotiated Rate |
$968.25 |
| Rate for Payer: Adventist Health Commercial |
$258.20
|
| Rate for Payer: Cash Price |
$710.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$874.01
|
| Rate for Payer: Heritage Provider Network Senior |
$874.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.75
|
| Rate for Payer: Multiplan Commercial |
$968.25
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
|
OP
|
$1,741.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,305.75 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$930.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,196.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$931.87
|
| Rate for Payer: Blue Shield of California EPN |
$749.38
|
| Rate for Payer: Cash Price |
$957.55
|
| Rate for Payer: Cash Price |
$957.55
|
| Rate for Payer: Cash Price |
$957.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,131.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,131.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,077.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,077.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$268.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$830.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$148.63
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,077.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$908.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
|
IP
|
$1,741.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$315.12 |
| Max. Negotiated Rate |
$1,305.75 |
| Rate for Payer: Adventist Health Commercial |
$348.20
|
| Rate for Payer: Cash Price |
$957.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,178.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,178.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.25
|
| Rate for Payer: Multiplan Commercial |
$1,305.75
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
|
IP
|
$11,242.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,034.80 |
| Max. Negotiated Rate |
$8,431.50 |
| Rate for Payer: Adventist Health Commercial |
$2,248.40
|
| Rate for Payer: Cash Price |
$6,183.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,610.83
|
| Rate for Payer: Heritage Provider Network Senior |
$7,610.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,034.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,810.50
|
| Rate for Payer: Multiplan Commercial |
$8,431.50
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
|
OP
|
$11,242.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,248.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,723.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$6,183.10
|
| Rate for Payer: Cash Price |
$6,183.10
|
| Rate for Payer: Cash Price |
$6,183.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,307.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Senior |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,484.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,958.80
|
| Rate for Payer: Heritage Provider Network Senior |
$5,515.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,985.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,519.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,034.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,156.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,810.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,649.87
|
| Rate for Payer: Multiplan Commercial |
$8,431.50
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,932.42
|
| Rate for Payer: TriValley Medical Group Senior |
$4,932.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
|
IP
|
$11,242.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,034.80 |
| Max. Negotiated Rate |
$8,431.50 |
| Rate for Payer: Adventist Health Commercial |
$2,248.40
|
| Rate for Payer: Cash Price |
$6,183.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,610.83
|
| Rate for Payer: Heritage Provider Network Senior |
$7,610.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,034.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,810.50
|
| Rate for Payer: Multiplan Commercial |
$8,431.50
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
|
OP
|
$11,242.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,248.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,723.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$6,183.10
|
| Rate for Payer: Cash Price |
$6,183.10
|
| Rate for Payer: Cash Price |
$6,183.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,307.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Senior |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,484.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,958.80
|
| Rate for Payer: Heritage Provider Network Senior |
$5,515.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,442.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,519.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,034.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,156.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,810.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,649.87
|
| Rate for Payer: Multiplan Commercial |
$8,431.50
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,932.42
|
| Rate for Payer: TriValley Medical Group Senior |
$4,932.42
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC PERC CECOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$8,168.00
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
909000215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,478.41 |
| Max. Negotiated Rate |
$6,126.00 |
| Rate for Payer: Adventist Health Commercial |
$1,633.60
|
| Rate for Payer: Cash Price |
$4,492.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,529.74
|
| Rate for Payer: Heritage Provider Network Senior |
$5,529.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.00
|
| Rate for Payer: Multiplan Commercial |
$6,126.00
|
|
|
HC PERC CECOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$8,168.00
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
909000215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,633.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,611.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| 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 |
$4,492.40
|
| Rate for Payer: Cash Price |
$4,492.40
|
| Rate for Payer: Cash Price |
$4,492.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,309.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Senior |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,498.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,055.99
|
| Rate for Payer: Heritage Provider Network Senior |
$1,842.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,443.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,846.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,478.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,722.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,042.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,887.66
|
| Rate for Payer: Multiplan Commercial |
$6,126.00
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,647.95
|
| Rate for Payer: TriValley Medical Group Senior |
$1,647.95
|
| 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 |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC PERC DRAINAGE W CATH PLACEMENT
|
Facility
|
OP
|
$1,995.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
906601707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.32 |
| Max. Negotiated Rate |
$1,695.75 |
| Rate for Payer: Adventist Health Commercial |
$399.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,024.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,370.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,695.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,097.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,496.25
|
| Rate for Payer: Blue Shield of California Commercial |
$664.90
|
| Rate for Payer: Blue Shield of California EPN |
$534.69
|
| Rate for Payer: Cash Price |
$1,097.25
|
| Rate for Payer: Cash Price |
$1,097.25
|
| Rate for Payer: Cash Price |
$1,097.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,296.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,695.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,695.75
|
| Rate for Payer: Dignity Health Senior |
$1,695.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,296.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,234.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,234.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$951.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,396.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,396.50
|
| Rate for Payer: Multiplan Commercial |
$1,496.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$997.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$997.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,695.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,695.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,695.75
|
|
|
HC PERC DRAINAGE W CATH PLACEMENT
|
Facility
|
IP
|
$1,995.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
906601707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$361.10 |
| Max. Negotiated Rate |
$1,496.25 |
| Rate for Payer: Adventist Health Commercial |
$399.00
|
| Rate for Payer: Cash Price |
$1,097.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,350.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,350.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$361.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.75
|
| Rate for Payer: Multiplan Commercial |
$1,496.25
|
|
|
HC PERC IMP NRSTML ELCTD ARRAY PN
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
CPT 64555
|
| Hospital Charge Code |
909004555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$15,843.76 |
| Rate for Payer: Adventist Health Commercial |
$3,766.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,936.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,508.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,172.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,338.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,379.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$10,356.50
|
| Rate for Payer: Cash Price |
$10,356.50
|
| Rate for Payer: Cash Price |
$10,356.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,239.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,508.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,172.70
|
| Rate for Payer: Dignity Health Senior |
$8,338.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,298.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,338.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,655.77
|
| Rate for Payer: Heritage Provider Network Senior |
$10,256.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,338.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,843.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,408.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,589.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,707.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,506.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,506.91
|
| Rate for Payer: Multiplan Commercial |
$14,122.50
|
| Rate for Payer: Multiplan WC |
$13,286.43
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,172.70
|
| Rate for Payer: TriValley Medical Group Senior |
$9,172.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,508.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,172.70
|
| Rate for Payer: Vantage Medical Group Senior |
$8,338.82
|
|
|
HC PERC IMP NRSTML ELCTD ARRAY PN
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
CPT 64555
|
| Hospital Charge Code |
909004555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,408.23 |
| Max. Negotiated Rate |
$14,122.50 |
| Rate for Payer: Adventist Health Commercial |
$3,766.00
|
| Rate for Payer: Cash Price |
$10,356.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,747.91
|
| Rate for Payer: Heritage Provider Network Senior |
$12,747.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,408.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,707.50
|
| Rate for Payer: Multiplan Commercial |
$14,122.50
|
|
|
HC PERC INJ W FL GDNC;1ST LVL
|
Facility
|
IP
|
$62,192.00
|
|
|
Service Code
|
CPT 0627T
|
| Hospital Charge Code |
909080627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,256.75 |
| Max. Negotiated Rate |
$46,644.00 |
| Rate for Payer: Adventist Health Commercial |
$12,438.40
|
| Rate for Payer: Cash Price |
$34,205.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$42,103.98
|
| Rate for Payer: Heritage Provider Network Senior |
$42,103.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,256.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,548.00
|
| Rate for Payer: Multiplan Commercial |
$46,644.00
|
|
|
HC PERC INJ W FL GDNC;1ST LVL
|
Facility
|
OP
|
$62,192.00
|
|
|
Service Code
|
CPT 0627T
|
| Hospital Charge Code |
909080627
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$46,644.00 |
| Rate for Payer: Adventist Health Commercial |
$12,438.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42,725.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,983.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,348.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$34,205.60
|
| Rate for Payer: Cash Price |
$34,205.60
|
| Rate for Payer: Cash Price |
$34,205.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40,424.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,983.44
|
| Rate for Payer: Dignity Health Senior |
$16,348.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$16,348.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$38,496.85
|
| Rate for Payer: Heritage Provider Network Senior |
$20,108.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,348.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$31,062.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,256.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,800.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,548.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,599.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20,599.21
|
| Rate for Payer: Multiplan Commercial |
$46,644.00
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$17,983.44
|
| Rate for Payer: TriValley Medical Group Senior |
$17,983.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,983.44
|
| Rate for Payer: Vantage Medical Group Senior |
$16,348.58
|
|
|
HC PERC INJ W FL GDNC; EA ADDL LVL
|
Facility
|
OP
|
$27,040.00
|
|
|
Service Code
|
CPT 0628T
|
| Hospital Charge Code |
909080628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$22,984.00 |
| Rate for Payer: Adventist Health Commercial |
$5,408.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$18,576.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,984.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,872.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,280.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| 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 |
$14,872.00
|
| Rate for Payer: Cash Price |
$14,872.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$17,576.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,984.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,984.00
|
| Rate for Payer: Dignity Health Senior |
$22,984.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16,737.76
|
| Rate for Payer: Heritage Provider Network Senior |
$16,737.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12,898.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,894.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,760.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,928.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,928.00
|
| Rate for Payer: Multiplan Commercial |
$20,280.00
|
| 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 |
$22,984.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,984.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22,984.00
|
|
|
HC PERC INJ W FL GDNC; EA ADDL LVL
|
Facility
|
IP
|
$27,040.00
|
|
|
Service Code
|
CPT 0628T
|
| Hospital Charge Code |
909080628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,894.24 |
| Max. Negotiated Rate |
$20,280.00 |
| Rate for Payer: Adventist Health Commercial |
$5,408.00
|
| Rate for Payer: Cash Price |
$14,872.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,306.08
|
| Rate for Payer: Heritage Provider Network Senior |
$18,306.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,894.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,760.00
|
| Rate for Payer: Multiplan Commercial |
$20,280.00
|
|
|
HC PERC LAMOT/LMNCTMY LUMBAR
|
Facility
|
IP
|
$28,660.00
|
|
|
Service Code
|
CPT 0275T
|
| Hospital Charge Code |
909003968
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,187.46 |
| Max. Negotiated Rate |
$21,495.00 |
| Rate for Payer: Adventist Health Commercial |
$5,732.00
|
| Rate for Payer: Cash Price |
$15,763.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,402.82
|
| Rate for Payer: Heritage Provider Network Senior |
$19,402.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,187.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,165.00
|
| Rate for Payer: Multiplan Commercial |
$21,495.00
|
|
|
HC PERC LAMOT/LMNCTMY LUMBAR
|
Facility
|
OP
|
$28,660.00
|
|
|
Service Code
|
CPT 0275T
|
| Hospital Charge Code |
909003968
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,959.00 |
| Max. Negotiated Rate |
$21,495.00 |
| Rate for Payer: Adventist Health Commercial |
$5,732.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$19,689.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$15,763.00
|
| Rate for Payer: Cash Price |
$15,763.00
|
| Rate for Payer: Cash Price |
$15,763.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18,629.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Senior |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,196.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,076.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$17,740.54
|
| Rate for Payer: Heritage Provider Network Senior |
$11,164.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$17,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,187.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,438.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,165.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,436.79
|
| Rate for Payer: Multiplan Commercial |
$21,495.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,984.50
|
| Rate for Payer: TriValley Medical Group Senior |
$9,984.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC PERC PLCMNT FIDUCIAL MRKR
|
Facility
|
IP
|
$3,248.00
|
|
|
Service Code
|
CPT 32553
|
| Hospital Charge Code |
900832553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$587.89 |
| Max. Negotiated Rate |
$2,436.00 |
| Rate for Payer: Adventist Health Commercial |
$649.60
|
| Rate for Payer: Cash Price |
$1,786.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,198.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,198.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$587.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.00
|
| Rate for Payer: Multiplan Commercial |
$2,436.00
|
|
|
HC PERC PLCMNT FIDUCIAL MRKR
|
Facility
|
OP
|
$3,248.00
|
|
|
Service Code
|
CPT 32553
|
| Hospital Charge Code |
900832553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$649.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,231.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,738.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$1,786.40
|
| Rate for Payer: Cash Price |
$1,786.40
|
| Rate for Payer: Cash Price |
$1,786.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,111.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,912.36
|
| Rate for Payer: Dignity Health Senior |
$1,738.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,738.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,010.51
|
| Rate for Payer: Heritage Provider Network Senior |
$2,138.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$841.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,738.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,303.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$587.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,999.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$812.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,190.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,190.52
|
| Rate for Payer: Multiplan Commercial |
$2,436.00
|
| Rate for Payer: Multiplan WC |
$2,770.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,912.36
|
| Rate for Payer: TriValley Medical Group Senior |
$1,912.36
|
| 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 |
$2,607.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,738.51
|
|
|
HC PERC PULM ART STENT ABN BI
|
Facility
|
OP
|
$29,512.00
|
|
|
Service Code
|
CPT 33903
|
| Hospital Charge Code |
906820326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$27,377.73 |
| Rate for Payer: Adventist Health Commercial |
$5,902.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,274.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| 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 |
$16,231.60
|
| Rate for Payer: Cash Price |
$16,231.60
|
| Rate for Payer: Cash Price |
$16,231.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,182.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Senior |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$14,409.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,267.93
|
| Rate for Payer: Heritage Provider Network Senior |
$17,723.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27,377.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,341.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,570.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,378.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,155.76
|
| Rate for Payer: Multiplan Commercial |
$22,134.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: TriValley Medical Group Commercial |
$15,850.26
|
| Rate for Payer: TriValley Medical Group Senior |
$15,850.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PERC PULM ART STENT ABN BI
|
Facility
|
IP
|
$29,512.00
|
|
|
Service Code
|
CPT 33903
|
| Hospital Charge Code |
906820326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,341.67 |
| Max. Negotiated Rate |
$22,134.00 |
| Rate for Payer: Adventist Health Commercial |
$5,902.40
|
| Rate for Payer: Cash Price |
$16,231.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$19,979.62
|
| Rate for Payer: Heritage Provider Network Senior |
$19,979.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,341.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,378.00
|
| Rate for Payer: Multiplan Commercial |
$22,134.00
|
|
|
HC PERC PULM ART STENT ABN UNI
|
Facility
|
OP
|
$45,368.00
|
|
|
Service Code
|
CPT 33902
|
| Hospital Charge Code |
906820322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$9,073.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31,167.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,720.00
|
| 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 |
$24,952.40
|
| Rate for Payer: Cash Price |
$24,952.40
|
| Rate for Payer: Cash Price |
$24,952.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29,489.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Senior |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,082.79
|
| Rate for Payer: Heritage Provider Network Senior |
$28,063.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$43,350.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,211.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,342.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28,747.92
|
| Rate for Payer: Multiplan Commercial |
$34,026.00
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,097.39
|
| Rate for Payer: TriValley Medical Group Senior |
$25,097.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
