|
HC PRGRMG DVC EVAL LEADLESS PMKR DC
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 0804T
|
| Hospital Charge Code |
906819787
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR DC
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 0804T
|
| Hospital Charge Code |
906819787
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$60.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.02
|
| 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 |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.66
|
| Rate for Payer: Heritage Provider Network Senior |
$59.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$91.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$66.33
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
|
|
HC PRGRMG DVC EVAL LEADLESS PMKR SC
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 0826T
|
| Hospital Charge Code |
906819776
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Adventist Health Commercial |
$20.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$63.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.52
|
| 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 |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.76
|
| Rate for Payer: Heritage Provider Network Senior |
$59.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$91.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$77.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$19,611.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,549.59 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,119.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,139.21
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,549.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,902.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$14,708.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$23,577.55
|
| 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 |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
OP
|
$19,611.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,549.59 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,119.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,747.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,139.21
|
| Rate for Payer: Heritage Provider Network Senior |
$29,000.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$44,797.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,549.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,902.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$14,708.25
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$25,935.31
|
| 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 |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$19,611.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
909081843
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,549.59 |
| Max. Negotiated Rate |
$14,708.25 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,629.48
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,276.65
|
| Rate for Payer: Heritage Provider Network Senior |
$13,276.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,549.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,902.75
|
| Rate for Payer: Multiplan Commercial |
$14,708.25
|
|
|
HC PRIM ART MECH THROMBECTOMY
|
Facility
|
IP
|
$19,611.00
|
|
|
Service Code
|
CPT 37184
|
| Hospital Charge Code |
906811428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,549.59 |
| Max. Negotiated Rate |
$14,708.25 |
| Rate for Payer: Adventist Health Commercial |
$3,922.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,629.48
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Cash Price |
$8,824.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,549.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,902.75
|
| Rate for Payer: Multiplan Commercial |
$14,708.25
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
OP
|
$16,468.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
909081844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$918.00 |
| Max. Negotiated Rate |
$13,997.80 |
| Rate for Payer: Adventist Health Commercial |
$3,293.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,177.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,997.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,057.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,351.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,704.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,997.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,997.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,997.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,193.69
|
| Rate for Payer: Heritage Provider Network Senior |
$10,193.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,855.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,980.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,117.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,527.60
|
| Rate for Payer: Multiplan Commercial |
$12,351.00
|
| 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 |
$13,997.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,997.80
|
| Rate for Payer: Vantage Medical Group Senior |
$13,997.80
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
IP
|
$16,468.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
909081844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,980.71 |
| Max. Negotiated Rate |
$12,351.00 |
| Rate for Payer: Adventist Health Commercial |
$3,293.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,605.39
|
| Rate for Payer: Cash Price |
$7,410.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,148.84
|
| Rate for Payer: Heritage Provider Network Senior |
$11,148.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,980.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,117.00
|
| Rate for Payer: Multiplan Commercial |
$12,351.00
|
|
|
HC PROBE NASOLACRIMAL DUCT W/ANES
|
Facility
|
IP
|
$4,628.00
|
|
|
Service Code
|
CPT 68811
|
| Hospital Charge Code |
900501656
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$837.67 |
| Max. Negotiated Rate |
$3,471.00 |
| Rate for Payer: Adventist Health Commercial |
$925.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,980.43
|
| Rate for Payer: Cash Price |
$2,082.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,133.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,133.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$837.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,157.00
|
| Rate for Payer: Multiplan Commercial |
$3,471.00
|
|
|
HC PROBE NASOLACRIMAL DUCT W/ANES
|
Facility
|
OP
|
$4,628.00
|
|
|
Service Code
|
CPT 68811
|
| Hospital Charge Code |
900501656
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$837.67 |
| Max. Negotiated Rate |
$4,723.01 |
| Rate for Payer: Adventist Health Commercial |
$925.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,860.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,198.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,749.38
|
| Rate for Payer: Cash Price |
$2,082.60
|
| Rate for Payer: Cash Price |
$2,082.60
|
| Rate for Payer: Cash Price |
$2,082.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,008.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,008.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,057.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,133.16
|
| Rate for Payer: Heritage Provider Network Senior |
$3,133.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,207.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$837.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,157.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$3,471.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,776.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2,776.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC PROBE NASOLACRIMAL DUCT W/TUBE
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
CPT 68815
|
| Hospital Charge Code |
900501677
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,142.72
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$883.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
|
|
HC PROBE NASOLACRIMAL DUCT W/TUBE
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
CPT 68815
|
| Hospital Charge Code |
900501677
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$5,158.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,015.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,318.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,844.64
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,172.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,172.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,057.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,327.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$883.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,928.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,928.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC PROB NASOLACRIMAL DUCT
|
Facility
|
IP
|
$2,107.00
|
|
|
Service Code
|
CPT 68810
|
| Hospital Charge Code |
900501582
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$381.37 |
| Max. Negotiated Rate |
$1,580.25 |
| Rate for Payer: Adventist Health Commercial |
$421.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,356.91
|
| Rate for Payer: Cash Price |
$948.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,426.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,426.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$381.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.75
|
| Rate for Payer: Multiplan Commercial |
$1,580.25
|
|
|
HC PROB NASOLACRIMAL DUCT
|
Facility
|
OP
|
$2,107.00
|
|
|
Service Code
|
CPT 68810
|
| Hospital Charge Code |
900501582
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$381.37 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$421.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,302.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,000.83
|
| Rate for Payer: Blue Shield of California EPN |
$796.45
|
| Rate for Payer: Cash Price |
$948.15
|
| Rate for Payer: Cash Price |
$948.15
|
| Rate for Payer: Cash Price |
$948.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,369.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,369.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$408.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,426.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,426.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,005.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$381.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$1,580.25
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,264.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1,264.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC PROB-NATRIURETIC PEPTIDE
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
900912306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$491.25 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$421.82
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$443.44
|
| Rate for Payer: Heritage Provider Network Senior |
$443.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.75
|
| Rate for Payer: Multiplan Commercial |
$491.25
|
|
|
HC PROB-NATRIURETIC PEPTIDE
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
900912306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$491.25 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.78
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$404.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.36
|
| Rate for Payer: Blue Shield of California Commercial |
$273.20
|
| Rate for Payer: Blue Shield of California Commercial |
$273.20
|
| Rate for Payer: Blue Shield of California EPN |
$219.13
|
| Rate for Payer: Blue Shield of California EPN |
$219.13
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$136.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$425.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$39.26
|
| Rate for Payer: EPIC Health Plan Medicare |
$39.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.44
|
| Rate for Payer: Heritage Provider Network Senior |
$129.99
|
| Rate for Payer: Heritage Provider Network Senior |
$405.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$100.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$312.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52.61
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$491.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$39.26
|
| Rate for Payer: TriValley Medical Group Commercial |
$39.26
|
| Rate for Payer: TriValley Medical Group Senior |
$39.26
|
| Rate for Payer: TriValley Medical Group Senior |
$39.26
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$42.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$42.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Vantage Medical Group Senior |
$39.26
|
| Rate for Payer: Vantage Medical Group Senior |
$39.26
|
|
|
HC PROCALCITONIN
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
900912171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$185.47
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
|
|
HC PROCALCITONIN
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
900912171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$113.09
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$177.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.55
|
| Rate for Payer: Blue Shield of California Commercial |
$159.90
|
| Rate for Payer: Blue Shield of California Commercial |
$159.90
|
| Rate for Payer: Blue Shield of California EPN |
$128.25
|
| Rate for Payer: Blue Shield of California EPN |
$128.25
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$118.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.97
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.22
|
| Rate for Payer: EPIC Health Plan Medicare |
$27.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$113.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$178.27
|
| Rate for Payer: Heritage Provider Network Senior |
$113.28
|
| Rate for Payer: Heritage Provider Network Senior |
$178.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$87.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$137.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.47
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.22
|
| Rate for Payer: TriValley Medical Group Commercial |
$27.22
|
| Rate for Payer: TriValley Medical Group Senior |
$27.22
|
| Rate for Payer: TriValley Medical Group Senior |
$27.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$29.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$29.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.94
|
| Rate for Payer: Vantage Medical Group Senior |
$27.22
|
| Rate for Payer: Vantage Medical Group Senior |
$27.22
|
|
|
HC PROC BILIARY TRACT
|
Facility
|
OP
|
$12,026.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
907247999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,166.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,405.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,432.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,712.35
|
| Rate for Payer: Blue Shield of California EPN |
$4,545.83
|
| Rate for Payer: Cash Price |
$5,411.70
|
| Rate for Payer: Cash Price |
$5,411.70
|
| Rate for Payer: Cash Price |
$5,411.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,816.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,141.60
|
| Rate for Payer: Heritage Provider Network Senior |
$8,141.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,736.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,176.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,006.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$9,019.50
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,215.60
|
| Rate for Payer: TriValley Medical Group Senior |
$7,215.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC PROC BILIARY TRACT
|
Facility
|
IP
|
$12,026.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
907247999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,176.71 |
| Max. Negotiated Rate |
$9,019.50 |
| Rate for Payer: Adventist Health Commercial |
$2,405.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,744.74
|
| Rate for Payer: Cash Price |
$5,411.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,141.60
|
| Rate for Payer: Heritage Provider Network Senior |
$8,141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,176.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,006.50
|
| Rate for Payer: Multiplan Commercial |
$9,019.50
|
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
900501221
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$966.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,015.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,015.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$271.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.00
|
| Rate for Payer: Multiplan Commercial |
$1,125.00
|
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
900501221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$966.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,015.50
|
| Rate for Payer: Heritage Provider Network Senior |
$1,015.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$271.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.00
|
| Rate for Payer: Multiplan Commercial |
$1,125.00
|
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
900501221
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$300.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$927.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$915.00
|
| Rate for Payer: Blue Shield of California EPN |
$732.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$975.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$928.50
|
| Rate for Payer: Heritage Provider Network Senior |
$928.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$715.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$271.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$1,125.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$335.09
|
| Rate for Payer: TriValley Medical Group Senior |
$304.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$575.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$483.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
