|
HC REV INCL RPLCMT SPNL NEURO ELEC
|
Facility
|
IP
|
$30,068.00
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
900100645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,442.31 |
| Max. Negotiated Rate |
$22,551.00 |
| Rate for Payer: Adventist Health Commercial |
$6,013.60
|
| Rate for Payer: Cash Price |
$13,530.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$20,356.04
|
| Rate for Payer: Heritage Provider Network Senior |
$20,356.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,442.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,517.00
|
| Rate for Payer: Multiplan Commercial |
$22,551.00
|
|
|
HC REV INCL RPLCMT SPNL NEURO ELEC
|
Facility
|
OP
|
$30,068.00
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
900100645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$22,551.00 |
| Rate for Payer: Adventist Health Commercial |
$6,013.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$20,656.72
|
| 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 |
$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 |
$13,530.60
|
| Rate for Payer: Cash Price |
$13,530.60
|
| Rate for Payer: Cash Price |
$13,530.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$19,544.20
|
| 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 |
$18,040.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,338.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$18,612.09
|
| Rate for Payer: Heritage Provider Network Senior |
$10,256.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.17
|
| 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 |
$5,442.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,589.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,517.00
|
| 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 |
$22,551.00
|
| 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 REVISE REMOVE NEURORECEIVER
|
Facility
|
IP
|
$14,480.00
|
|
|
Service Code
|
CPT 63688
|
| Hospital Charge Code |
909000688
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,620.88 |
| Max. Negotiated Rate |
$10,860.00 |
| Rate for Payer: Adventist Health Commercial |
$2,896.00
|
| Rate for Payer: Cash Price |
$6,516.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,802.96
|
| Rate for Payer: Heritage Provider Network Senior |
$9,802.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,620.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,620.00
|
| Rate for Payer: Multiplan Commercial |
$10,860.00
|
|
|
HC REVISE REMOVE NEURORECEIVER
|
Facility
|
OP
|
$14,480.00
|
|
|
Service Code
|
CPT 63688
|
| Hospital Charge Code |
909000688
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,860.00 |
| Rate for Payer: Adventist Health Commercial |
$2,896.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,947.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,554.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,806.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,369.61
|
| 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 |
$6,516.00
|
| Rate for Payer: Cash Price |
$6,516.00
|
| Rate for Payer: Cash Price |
$6,516.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,412.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,554.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,806.57
|
| Rate for Payer: Dignity Health Senior |
$4,369.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,688.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,369.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,963.12
|
| Rate for Payer: Heritage Provider Network Senior |
$5,374.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$490.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,369.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,302.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,620.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,025.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,620.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,505.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,505.71
|
| Rate for Payer: Multiplan Commercial |
$10,860.00
|
| Rate for Payer: Multiplan WC |
$6,962.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,806.57
|
| Rate for Payer: TriValley Medical Group Senior |
$4,806.57
|
| 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 |
$6,554.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,806.57
|
| Rate for Payer: Vantage Medical Group Senior |
$4,369.61
|
|
|
HC REVISION GASTRODUO WO VAGOTOMY
|
Facility
|
OP
|
$10,218.00
|
|
|
Service Code
|
CPT 43850
|
| Hospital Charge Code |
906743850
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,043.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,461.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,019.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,619.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,663.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| 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 |
$4,598.10
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,641.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,685.30
|
| Rate for Payer: Dignity Health Senior |
$8,685.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,324.94
|
| Rate for Payer: Heritage Provider Network Senior |
$6,324.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,873.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,849.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,152.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,152.60
|
| Rate for Payer: Multiplan Commercial |
$7,663.50
|
| 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 |
$5,109.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,109.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,685.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8,685.30
|
|
|
HC REVISION GASTRODUO WO VAGOTOMY
|
Facility
|
IP
|
$10,218.00
|
|
|
Service Code
|
CPT 43850
|
| Hospital Charge Code |
906743850
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,849.46 |
| Max. Negotiated Rate |
$7,663.50 |
| Rate for Payer: Adventist Health Commercial |
$2,043.60
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,917.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6,917.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,849.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.50
|
| Rate for Payer: Multiplan Commercial |
$7,663.50
|
|
|
HC REVISION GASTRODUO W VAGOTOMY
|
Facility
|
IP
|
$10,218.00
|
|
|
Service Code
|
CPT 43855
|
| Hospital Charge Code |
906743855
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,849.46 |
| Max. Negotiated Rate |
$7,663.50 |
| Rate for Payer: Adventist Health Commercial |
$2,043.60
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,917.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6,917.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,849.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.50
|
| Rate for Payer: Multiplan Commercial |
$7,663.50
|
|
|
HC REVISION GASTRODUO W VAGOTOMY
|
Facility
|
OP
|
$10,218.00
|
|
|
Service Code
|
CPT 43855
|
| Hospital Charge Code |
906743855
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,043.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,461.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,019.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,619.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,663.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| 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 |
$4,598.10
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,641.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,685.30
|
| Rate for Payer: Dignity Health Senior |
$8,685.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,324.94
|
| Rate for Payer: Heritage Provider Network Senior |
$6,324.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,873.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,849.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,152.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,152.60
|
| Rate for Payer: Multiplan Commercial |
$7,663.50
|
| 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 |
$5,109.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,109.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,685.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8,685.30
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$41,423.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,497.56 |
| Max. Negotiated Rate |
$31,067.25 |
| Rate for Payer: Adventist Health Commercial |
$8,284.60
|
| Rate for Payer: Cash Price |
$18,640.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,043.37
|
| Rate for Payer: Heritage Provider Network Senior |
$28,043.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,497.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,355.75
|
| Rate for Payer: Multiplan Commercial |
$31,067.25
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$41,423.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$31,067.25 |
| Rate for Payer: Adventist Health Commercial |
$8,284.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$28,457.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,354.00
|
| 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 |
$18,640.35
|
| Rate for Payer: Cash Price |
$18,640.35
|
| Rate for Payer: Cash Price |
$18,640.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26,924.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Senior |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,640.84
|
| Rate for Payer: Heritage Provider Network Senior |
$8,910.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$404.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,764.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,497.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,331.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,355.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,127.88
|
| Rate for Payer: Multiplan Commercial |
$31,067.25
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,968.78
|
| Rate for Payer: TriValley Medical Group Senior |
$7,968.78
|
| 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 |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC REVISION OF EYELID
|
Facility
|
OP
|
$3,246.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$379.82 |
| Max. Negotiated Rate |
$2,434.50 |
| Rate for Payer: Adventist Health Commercial |
$649.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,734.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,230.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.00
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Senior |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,109.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$379.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,197.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,197.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,548.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$587.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$811.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.57
|
| Rate for Payer: Multiplan Commercial |
$2,434.50
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,167.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,074.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC REVISION OF EYELID
|
Facility
|
IP
|
$3,246.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$587.53 |
| Max. Negotiated Rate |
$2,434.50 |
| Rate for Payer: Adventist Health Commercial |
$649.20
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,197.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,197.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$587.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$811.50
|
| Rate for Payer: Multiplan Commercial |
$2,434.50
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
IP
|
$51,245.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,275.34 |
| Max. Negotiated Rate |
$38,433.75 |
| Rate for Payer: Adventist Health Commercial |
$10,249.00
|
| Rate for Payer: Cash Price |
$23,060.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$34,692.86
|
| Rate for Payer: Heritage Provider Network Senior |
$34,692.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,275.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,811.25
|
| Rate for Payer: Multiplan Commercial |
$38,433.75
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
OP
|
$51,245.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$43,350.04 |
| Rate for Payer: Adventist Health Commercial |
$10,249.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$35,205.32
|
| 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 |
$8,785.00
|
| 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 |
$23,060.25
|
| Rate for Payer: Cash Price |
$23,060.25
|
| Rate for Payer: Cash Price |
$23,060.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33,309.25
|
| 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 |
$30,747.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,815.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$31,720.65
|
| 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 |
$9,275.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26,238.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,811.25
|
| 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 |
$38,433.75
|
| 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
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
IP
|
$5,229.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$946.45 |
| Max. Negotiated Rate |
$3,921.75 |
| Rate for Payer: Adventist Health Commercial |
$1,045.80
|
| Rate for Payer: Cash Price |
$2,353.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,540.03
|
| Rate for Payer: Heritage Provider Network Senior |
$3,540.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,307.25
|
| Rate for Payer: Multiplan Commercial |
$3,921.75
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
OP
|
$5,229.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,045.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,592.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| 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 |
$2,353.05
|
| Rate for Payer: Cash Price |
$2,353.05
|
| Rate for Payer: Cash Price |
$2,353.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,398.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Senior |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,481.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,236.75
|
| Rate for Payer: Heritage Provider Network Senior |
$3,051.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$739.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,714.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,853.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,307.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,126.30
|
| Rate for Payer: Multiplan Commercial |
$3,921.75
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,729.31
|
| Rate for Payer: TriValley Medical Group Senior |
$2,729.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
IP
|
$4,220.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$763.82 |
| Max. Negotiated Rate |
$3,165.00 |
| Rate for Payer: Adventist Health Commercial |
$844.00
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,856.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2,856.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$763.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.00
|
| Rate for Payer: Multiplan Commercial |
$3,165.00
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
OP
|
$4,220.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$844.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,899.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,587.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,321.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,165.00
|
| 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 |
$1,899.00
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,743.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,587.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,587.00
|
| Rate for Payer: Dignity Health Senior |
$3,587.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,532.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,612.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,012.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$763.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,954.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,954.00
|
| Rate for Payer: Multiplan Commercial |
$3,165.00
|
| 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 |
$3,587.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,587.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,587.00
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
OP
|
$4,220.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$844.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,899.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,587.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,321.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,165.00
|
| 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 |
$1,899.00
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,743.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,587.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,587.00
|
| Rate for Payer: Dignity Health Senior |
$3,587.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,532.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,612.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,012.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$763.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,954.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,954.00
|
| Rate for Payer: Multiplan Commercial |
$3,165.00
|
| 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 |
$3,587.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,587.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,587.00
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
IP
|
$4,220.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$763.82 |
| Max. Negotiated Rate |
$3,165.00 |
| Rate for Payer: Adventist Health Commercial |
$844.00
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,856.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2,856.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$763.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.00
|
| Rate for Payer: Multiplan Commercial |
$3,165.00
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,940.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| 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 |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,674.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Senior |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,315.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,481.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,451.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,051.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$323.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,714.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,853.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,126.30
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,729.31
|
| Rate for Payer: TriValley Medical Group Senior |
$2,729.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,868.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,868.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,940.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| 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 |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,674.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Senior |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,315.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,481.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,451.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,051.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,714.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,853.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,126.30
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,729.31
|
| Rate for Payer: TriValley Medical Group Senior |
$2,729.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,868.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,868.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
|
|
HC RF MAGNETIC-GUIDE AV FISTULA
|
Facility
|
OP
|
$21,414.00
|
|
|
Service Code
|
CPT G2171
|
| Hospital Charge Code |
909000755
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,875.93 |
| Max. Negotiated Rate |
$18,201.90 |
| Rate for Payer: Adventist Health Commercial |
$4,282.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$14,711.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,201.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,777.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,060.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| 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 |
$9,636.30
|
| Rate for Payer: Cash Price |
$9,636.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,919.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,201.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,201.90
|
| Rate for Payer: Dignity Health Senior |
$18,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,848.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,255.27
|
| Rate for Payer: Heritage Provider Network Senior |
$13,255.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$10,214.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,875.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,353.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,989.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,989.80
|
| Rate for Payer: Multiplan Commercial |
$16,060.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,707.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,707.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,201.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,201.90
|
| Rate for Payer: Vantage Medical Group Senior |
$18,201.90
|
|
