|
HC REPLCMNT GJ TUBE WO FLUORO
|
Facility
IP
|
$4,179.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743990
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$756.40 |
| Max. Negotiated Rate |
$3,134.25 |
| Rate for Payer: Adventist Health Commercial |
$835.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,870.97
|
| Rate for Payer: Cash Price |
$1,880.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,829.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2,829.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$756.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.75
|
| Rate for Payer: Multiplan Commercial |
$3,134.25
|
|
|
HC REPLCMNT GJ TUBE WO FLUORO
|
Facility
OP
|
$4,179.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743990
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$835.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,870.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,880.55
|
| Rate for Payer: Cash Price |
$1,880.55
|
| Rate for Payer: Cash Price |
$1,880.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,716.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,586.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$756.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,134.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
OP
|
$4,318.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$781.56 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,806.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,923.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,923.29
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,081.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,567.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,442.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
OP
|
$4,318.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,806.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,672.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$98.75
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,201.11
|
| Rate for Payer: TriValley Medical Group Senior |
$2,201.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
IP
|
$4,318.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$781.56 |
| Max. Negotiated Rate |
$3,238.50 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,923.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,923.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
|
|
HC REPLC PERIPH INSRT CV CATH W/O
|
Facility
IP
|
$4,318.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
909080020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$781.56 |
| Max. Negotiated Rate |
$3,238.50 |
| Rate for Payer: Adventist Health Commercial |
$863.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,966.47
|
| Rate for Payer: Cash Price |
$1,943.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,923.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,923.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.50
|
| Rate for Payer: Multiplan Commercial |
$3,238.50
|
|
|
HC REPLC TUN CNTRL INSRT CATH W/O
|
Facility
OP
|
$8,426.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
909080019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$272.89 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,685.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,788.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,476.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,215.69
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$272.89
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,525.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,106.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,319.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REPLC TUN CNTRL INSRT CATH W/O
|
Facility
IP
|
$8,426.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
909080019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,525.11 |
| Max. Negotiated Rate |
$6,319.50 |
| Rate for Payer: Adventist Health Commercial |
$1,685.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,788.66
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,704.40
|
| Rate for Payer: Heritage Provider Network Senior |
$5,704.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,525.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,106.50
|
| Rate for Payer: Multiplan Commercial |
$6,319.50
|
|
|
HC REP LEG TENDON PRIMARY EA
|
Facility
OP
|
$6,736.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
900501603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,407.80 |
| Rate for Payer: Adventist Health Commercial |
$1,347.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,627.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,378.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,560.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,560.27
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,246.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$5,052.00
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,445.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,250.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC REP LEG TENDON PRIMARY EA
|
Facility
IP
|
$6,736.00
|
|
|
Service Code
|
CPT 27664
|
| Hospital Charge Code |
900501603
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,219.22 |
| Max. Negotiated Rate |
$5,052.00 |
| Rate for Payer: Adventist Health Commercial |
$1,347.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,627.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,842.59
|
| Rate for Payer: Blue Shield of California EPN |
$2,707.87
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,560.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,560.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.00
|
| Rate for Payer: Multiplan Commercial |
$5,052.00
|
|
|
HC REPL TUNNELED CV CATH W PUMP
|
Facility
OP
|
$12,804.00
|
|
|
Service Code
|
CPT 36583
|
| Hospital Charge Code |
909086583
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$319.44 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$2,560.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,796.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,562.15
|
| Rate for Payer: Blue Shield of California EPN |
$6,499.32
|
| Rate for Payer: Cash Price |
$5,761.80
|
| Rate for Payer: Cash Price |
$5,761.80
|
| Rate for Payer: Cash Price |
$5,761.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,322.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,925.68
|
| Rate for Payer: Heritage Provider Network Senior |
$8,445.27
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: IEHP Medi-Cal |
$319.44
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,317.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,201.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$9,603.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,552.68
|
| Rate for Payer: TriValley Medical Group Senior |
$7,552.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC REPL TUNNELED CV CATH W PUMP
|
Facility
IP
|
$12,804.00
|
|
|
Service Code
|
CPT 36583
|
| Hospital Charge Code |
909086583
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,317.52 |
| Max. Negotiated Rate |
$9,603.00 |
| Rate for Payer: Adventist Health Commercial |
$2,560.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,796.35
|
| Rate for Payer: Cash Price |
$5,761.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,668.31
|
| Rate for Payer: Heritage Provider Network Senior |
$8,668.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,317.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,201.00
|
| Rate for Payer: Multiplan Commercial |
$9,603.00
|
|
|
HC REP OF NAIL BED
|
Facility
IP
|
$922.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
900501018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$691.50 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$633.41
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$624.19
|
| Rate for Payer: Heritage Provider Network Senior |
$624.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.50
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
|
|
HC REP OF NAIL BED
|
Facility
OP
|
$922.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
900501018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$633.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$599.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: Dignity Health Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$624.19
|
| Rate for Payer: Heritage Provider Network Senior |
$624.19
|
| Rate for Payer: Humana Medicare |
$784.71
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$444.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.73
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$334.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$308.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REPOSITION CENTRAL CATH PICC
|
Facility
IP
|
$3,038.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
901200119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$549.88 |
| Max. Negotiated Rate |
$2,278.50 |
| Rate for Payer: Adventist Health Commercial |
$607.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,087.11
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,056.73
|
| Rate for Payer: Heritage Provider Network Senior |
$2,056.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$549.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$759.50
|
| Rate for Payer: Multiplan Commercial |
$2,278.50
|
|
|
HC REPOSITION CENTRAL CATH PICC
|
Facility
OP
|
$3,038.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
901200119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$549.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$607.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,087.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,974.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,056.73
|
| Rate for Payer: Heritage Provider Network Senior |
$2,056.73
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,464.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$549.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$759.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$2,278.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,103.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,015.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
OP
|
$4,296.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906820089
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$859.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,951.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,792.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,659.22
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$69.70
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$777.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,074.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$3,222.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,201.11
|
| Rate for Payer: TriValley Medical Group Senior |
$2,201.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
IP
|
$4,296.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906820089
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$777.58 |
| Max. Negotiated Rate |
$3,222.00 |
| Rate for Payer: Adventist Health Commercial |
$859.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,951.35
|
| Rate for Payer: Cash Price |
$1,933.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,908.39
|
| Rate for Payer: Heritage Provider Network Senior |
$2,908.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$777.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,074.00
|
| Rate for Payer: Multiplan Commercial |
$3,222.00
|
|
|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
OP
|
$3,444.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906812250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$688.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,366.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,549.80
|
| Rate for Payer: Cash Price |
$1,549.80
|
| Rate for Payer: Cash Price |
$1,549.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,238.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,131.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$69.70
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$623.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$861.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$2,583.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,201.11
|
| Rate for Payer: TriValley Medical Group Senior |
$2,201.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
IP
|
$3,444.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906812250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$623.36 |
| Max. Negotiated Rate |
$2,583.00 |
| Rate for Payer: Adventist Health Commercial |
$688.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,366.03
|
| Rate for Payer: Cash Price |
$1,549.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,331.59
|
| Rate for Payer: Heritage Provider Network Senior |
$2,331.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$623.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$861.00
|
| Rate for Payer: Multiplan Commercial |
$2,583.00
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
IP
|
$10,328.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,869.37 |
| Max. Negotiated Rate |
$7,746.00 |
| Rate for Payer: Adventist Health Commercial |
$2,065.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,095.34
|
| Rate for Payer: Cash Price |
$4,647.60
|
| Rate for Payer: Cash Price |
$4,647.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,869.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,582.00
|
| Rate for Payer: Multiplan Commercial |
$7,746.00
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
OP
|
$10,328.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$45.30 |
| Max. Negotiated Rate |
$10,742.00 |
| Rate for Payer: Adventist Health Commercial |
$2,065.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$371.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,095.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,778.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,680.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,746.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,231.15
|
| Rate for Payer: Blue Shield of California EPN |
$8,793.20
|
| Rate for Payer: Cash Price |
$4,647.60
|
| Rate for Payer: Cash Price |
$4,647.60
|
| Rate for Payer: Cash Price |
$4,647.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,778.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,778.80
|
| Rate for Payer: Dignity Health Senior |
$8,778.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,393.03
|
| Rate for Payer: Heritage Provider Network Senior |
$6,393.03
|
| Rate for Payer: IEHP Medi-Cal |
$45.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,978.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,869.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,582.00
|
| Rate for Payer: Multiplan Commercial |
$7,746.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,778.80
|
| Rate for Payer: Vantage Medical Group Senior |
$8,778.80
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
OP
|
$7,597.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906820234
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$45.30 |
| Max. Negotiated Rate |
$10,742.00 |
| Rate for Payer: Adventist Health Commercial |
$1,519.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$371.87
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,219.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,457.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,178.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,697.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,742.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,231.15
|
| Rate for Payer: Blue Shield of California EPN |
$8,793.20
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,457.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,457.45
|
| Rate for Payer: Dignity Health Senior |
$6,457.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,702.54
|
| Rate for Payer: Heritage Provider Network Senior |
$4,702.54
|
| Rate for Payer: IEHP Medi-Cal |
$45.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,661.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,375.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,899.25
|
| Rate for Payer: Multiplan Commercial |
$5,697.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,457.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,457.45
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
IP
|
$7,597.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906820234
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,375.06 |
| Max. Negotiated Rate |
$5,697.75 |
| Rate for Payer: Adventist Health Commercial |
$1,519.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,219.14
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,375.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,899.25
|
| Rate for Payer: Multiplan Commercial |
$5,697.75
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
IP
|
$13,810.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,499.61 |
| Max. Negotiated Rate |
$10,357.50 |
| Rate for Payer: Adventist Health Commercial |
$2,762.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,487.47
|
| Rate for Payer: Blue Shield of California Commercial |
$5,827.82
|
| Rate for Payer: Blue Shield of California EPN |
$5,551.62
|
| Rate for Payer: Cash Price |
$6,214.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,349.37
|
| Rate for Payer: Heritage Provider Network Senior |
$9,349.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,499.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,452.50
|
| Rate for Payer: Multiplan Commercial |
$10,357.50
|
|
