|
HC PERCT PLCMNT DUODENAL/JEJUNOST
|
Facility
|
IP
|
$6,157.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
909020003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,114.42 |
| Max. Negotiated Rate |
$4,617.75 |
| Rate for Payer: Adventist Health Commercial |
$1,231.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,965.11
|
| Rate for Payer: Cash Price |
$2,770.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,168.29
|
| Rate for Payer: Heritage Provider Network Senior |
$4,168.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,114.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.25
|
| Rate for Payer: Multiplan Commercial |
$4,617.75
|
|
|
HC PERC TRANSPORTAL W HEMO
|
Facility
|
OP
|
$7,293.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
909081690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,320.03 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$1,458.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,507.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,422.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$3,281.85
|
| Rate for Payer: Cash Price |
$3,281.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,740.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,302.87
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,514.37
|
| Rate for Payer: Heritage Provider Network Senior |
$4,514.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,478.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,320.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$5,469.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC PERC TRANSPORTAL W HEMO
|
Facility
|
IP
|
$7,293.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
909081690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,320.03 |
| Max. Negotiated Rate |
$5,469.75 |
| Rate for Payer: Adventist Health Commercial |
$1,458.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,696.69
|
| Rate for Payer: Cash Price |
$3,281.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,937.36
|
| Rate for Payer: Heritage Provider Network Senior |
$4,937.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,320.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.25
|
| Rate for Payer: Multiplan Commercial |
$5,469.75
|
|
|
HC PERC TRANSPORTAL W/O HEMO
|
Facility
|
IP
|
$3,474.00
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
909081691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$628.79 |
| Max. Negotiated Rate |
$2,605.50 |
| Rate for Payer: Adventist Health Commercial |
$694.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,237.26
|
| Rate for Payer: Cash Price |
$1,563.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,351.90
|
| Rate for Payer: Heritage Provider Network Senior |
$2,351.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$628.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$868.50
|
| Rate for Payer: Multiplan Commercial |
$2,605.50
|
|
|
HC PERC TRANSPORTAL W/O HEMO
|
Facility
|
OP
|
$3,474.00
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
909081691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$628.79 |
| Max. Negotiated Rate |
$6,091.57 |
| Rate for Payer: Adventist Health Commercial |
$694.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,146.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,422.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$1,563.30
|
| Rate for Payer: Cash Price |
$1,563.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,258.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,049.66
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,150.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,150.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,657.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$628.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$868.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$2,605.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,055.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,055.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
OP
|
$10,219.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
906811715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,849.64 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$2,043.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,315.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,686.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,620.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,664.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,111.54
|
| 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 |
$4,598.55
|
| Rate for Payer: Cash Price |
$4,598.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,642.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,686.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,686.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,686.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,131.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,325.56
|
| Rate for Payer: Heritage Provider Network Senior |
$6,325.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,874.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,849.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,153.30
|
| Rate for Payer: Multiplan Commercial |
$7,664.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,109.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,109.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,686.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,686.15
|
| Rate for Payer: Vantage Medical Group Senior |
$8,686.15
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
IP
|
$10,219.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
906811715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,849.64 |
| Max. Negotiated Rate |
$7,664.25 |
| Rate for Payer: Adventist Health Commercial |
$2,043.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,581.04
|
| Rate for Payer: Cash Price |
$4,598.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,918.26
|
| Rate for Payer: Heritage Provider Network Senior |
$6,918.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,849.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.75
|
| Rate for Payer: Multiplan Commercial |
$7,664.25
|
|
|
HC PERC TRT FX GREAT TOE, W/MANIP
|
Facility
|
IP
|
$6,090.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
900501250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,921.96
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,102.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
|
|
HC PERC TRT FX GREAT TOE, W/MANIP
|
Facility
|
OP
|
$6,090.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
900501250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,763.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,892.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,302.02
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,958.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,904.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,102.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,654.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,654.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC PERC T-TUBE CATH COOK MSPT1400
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$162.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$105.73
|
| Rate for Payer: Blue Shield of California EPN |
$105.73
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.77
|
| Rate for Payer: Heritage Provider Network Senior |
$121.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$131.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$184.10
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
|
HC PERC T-TUBE CATH COOK MSPT1400
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$169.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$105.73
|
| Rate for Payer: Blue Shield of California EPN |
$105.73
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$120.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$121.77
|
| Rate for Payer: Heritage Provider Network Senior |
$121.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$131.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.75
|
| Rate for Payer: Multiplan Commercial |
$197.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$95.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$87.08
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
|
OP
|
$2,026.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$366.71 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$405.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,252.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,013.41
|
| 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 |
$911.70
|
| Rate for Payer: Cash Price |
$911.70
|
| Rate for Payer: Cash Price |
$911.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,316.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$910.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,254.09
|
| Rate for Payer: Heritage Provider Network Senior |
$1,120.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,730.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$366.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,047.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$1,519.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,001.86
|
| Rate for Payer: TriValley Medical Group Senior |
$1,001.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
|
IP
|
$2,026.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$366.71 |
| Max. Negotiated Rate |
$1,519.50 |
| Rate for Payer: Adventist Health Commercial |
$405.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,304.74
|
| Rate for Payer: Cash Price |
$911.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,371.60
|
| Rate for Payer: Heritage Provider Network Senior |
$1,371.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$366.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$506.50
|
| Rate for Payer: Multiplan Commercial |
$1,519.50
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
|
OP
|
$12,379.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,240.60 |
| Max. Negotiated Rate |
$42,847.70 |
| Rate for Payer: Adventist Health Commercial |
$2,475.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,650.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,551.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$5,570.55
|
| Rate for Payer: Cash Price |
$5,570.55
|
| Rate for Payer: Cash Price |
$5,570.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,046.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,806.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,551.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,551.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,662.60
|
| Rate for Payer: Heritage Provider Network Senior |
$27,738.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,551.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42,847.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,240.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25,934.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,094.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,218.90
|
| Rate for Payer: Multiplan Commercial |
$9,284.25
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,806.56
|
| Rate for Payer: TriValley Medical Group Senior |
$24,806.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12,150.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,259.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Vantage Medical Group Senior |
$22,551.42
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
|
IP
|
$12,379.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,240.60 |
| Max. Negotiated Rate |
$9,284.25 |
| Rate for Payer: Adventist Health Commercial |
$2,475.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,972.08
|
| Rate for Payer: Cash Price |
$5,570.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,380.58
|
| Rate for Payer: Heritage Provider Network Senior |
$8,380.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,240.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,094.75
|
| Rate for Payer: Multiplan Commercial |
$9,284.25
|
|
|
HC PERCU-STAY
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
909001085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.50
|
| Rate for Payer: Blue Shield of California Commercial |
$11.59
|
| Rate for Payer: Blue Shield of California EPN |
$9.27
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.76
|
| Rate for Payer: Heritage Provider Network Senior |
$11.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.30
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.15
|
| Rate for Payer: Vantage Medical Group Senior |
$16.15
|
|
|
HC PERCU-STAY
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
909001085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12.24
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.86
|
| Rate for Payer: Heritage Provider Network Senior |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
|
|
HC PERCUTANE DISTAL PHAL FRAC EA
|
Facility
|
IP
|
$6,090.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
900501333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$4,567.50 |
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,921.96
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,102.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
|
|
HC PERCUTANE DISTAL PHAL FRAC EA
|
Facility
|
OP
|
$6,090.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
900501333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,102.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Multiplan Commercial |
$4,567.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Adventist Health Commercial |
$1,218.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,763.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,892.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,302.02
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cash Price |
$2,740.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,958.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,122.93
|
| Rate for Payer: Heritage Provider Network Senior |
$4,122.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,904.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,102.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,522.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,654.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,654.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC PERCUTANEOUS SKELETAL FIXATION
|
Facility
|
IP
|
$6,189.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
900501694
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,120.21 |
| Max. Negotiated Rate |
$4,641.75 |
| Rate for Payer: Adventist Health Commercial |
$1,237.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,985.72
|
| Rate for Payer: Cash Price |
$2,785.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,189.95
|
| Rate for Payer: Heritage Provider Network Senior |
$4,189.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,120.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,547.25
|
| Rate for Payer: Multiplan Commercial |
$4,641.75
|
|
|
HC PERCUTANEOUS SKELETAL FIXATION
|
Facility
|
OP
|
$6,189.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
900501694
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,120.21 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$1,237.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,824.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,939.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,339.44
|
| Rate for Payer: Cash Price |
$2,785.05
|
| Rate for Payer: Cash Price |
$2,785.05
|
| Rate for Payer: Cash Price |
$2,785.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,022.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,189.95
|
| Rate for Payer: Heritage Provider Network Senior |
$4,189.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,952.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,120.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,547.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$4,641.75
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,713.40
|
| Rate for Payer: TriValley Medical Group Senior |
$3,713.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC PERCUT RETRIEVAL F B
|
Facility
|
OP
|
$20,447.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,700.91 |
| Max. Negotiated Rate |
$15,335.25 |
| Rate for Payer: Adventist Health Commercial |
$4,089.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,636.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,472.67
|
| Rate for Payer: Blue Shield of California EPN |
$9,978.14
|
| Rate for Payer: Cash Price |
$9,201.15
|
| Rate for Payer: Cash Price |
$9,201.15
|
| Rate for Payer: Cash Price |
$9,201.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,290.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,656.69
|
| Rate for Payer: Heritage Provider Network Senior |
$12,656.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,753.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,700.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,111.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$15,335.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,061.05
|
| Rate for Payer: TriValley Medical Group Senior |
$4,061.05
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,223.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,223.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC PERCUT RETRIEVAL F B
|
Facility
|
IP
|
$20,447.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,700.91 |
| Max. Negotiated Rate |
$15,335.25 |
| Rate for Payer: Adventist Health Commercial |
$4,089.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,167.87
|
| Rate for Payer: Cash Price |
$9,201.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,842.62
|
| Rate for Payer: Heritage Provider Network Senior |
$13,842.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,700.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,111.75
|
| Rate for Payer: Multiplan Commercial |
$15,335.25
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
|
IP
|
$10,460.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,893.26 |
| Max. Negotiated Rate |
$7,845.00 |
| Rate for Payer: Adventist Health Commercial |
$2,092.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,736.24
|
| Rate for Payer: Cash Price |
$4,707.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,081.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,081.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,893.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.00
|
| Rate for Payer: Multiplan Commercial |
$7,845.00
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
|
OP
|
$10,460.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,893.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,092.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,464.28
|
| 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 |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,968.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,953.88
|
| Rate for Payer: Cash Price |
$4,707.00
|
| Rate for Payer: Cash Price |
$4,707.00
|
| Rate for Payer: Cash Price |
$4,707.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,799.00
|
| 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 |
$7,081.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,081.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,989.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,893.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,615.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$7,845.00
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,276.00
|
| Rate for Payer: TriValley Medical Group Senior |
$6,276.00
|
| 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
|
|
