|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.82 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Adventist Health Commercial |
$220.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$710.98
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$747.41
|
| Rate for Payer: Heritage Provider Network Senior |
$747.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.82 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$220.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$682.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$938.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$607.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$828.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$524.40
|
| Rate for Payer: Blue Shield of California EPN |
$417.31
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$717.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$938.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$938.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$747.41
|
| Rate for Payer: Heritage Provider Network Senior |
$747.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$526.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$772.80
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$662.40
|
| Rate for Payer: TriValley Medical Group Senior |
$662.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$938.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.40
|
| Rate for Payer: Vantage Medical Group Senior |
$938.40
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,497.78 |
| Max. Negotiated Rate |
$6,206.25 |
| Rate for Payer: Adventist Health Commercial |
$1,655.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,329.10
|
| Rate for Payer: Cash Price |
$3,723.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,602.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5,602.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,497.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,068.75
|
| Rate for Payer: Multiplan Commercial |
$6,206.25
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,497.78 |
| Max. Negotiated Rate |
$12,964.88 |
| Rate for Payer: Adventist Health Commercial |
$1,655.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,113.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,590.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,833.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,393.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,930.62
|
| Rate for Payer: Blue Shield of California EPN |
$3,127.95
|
| Rate for Payer: Cash Price |
$3,723.75
|
| Rate for Payer: Cash Price |
$3,723.75
|
| Rate for Payer: Cash Price |
$3,723.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,378.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,590.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,833.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,393.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,378.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,393.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,602.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5,602.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,393.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,947.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,497.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,052.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,068.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,887.61
|
| Rate for Payer: Multiplan Commercial |
$6,206.25
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,965.00
|
| Rate for Payer: TriValley Medical Group Senior |
$4,965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,590.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,833.11
|
| Rate for Payer: Vantage Medical Group Senior |
$4,393.74
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
OP
|
$13,120.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,374.72 |
| Max. Negotiated Rate |
$9,840.00 |
| Rate for Payer: Adventist Health Commercial |
$2,624.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,108.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,232.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,959.36
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,528.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,604.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,882.24
|
| Rate for Payer: Heritage Provider Network Senior |
$8,882.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,258.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,374.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,295.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,280.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$9,840.00
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,872.00
|
| Rate for Payer: TriValley Medical Group Senior |
$7,872.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
IP
|
$13,120.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,374.72 |
| Max. Negotiated Rate |
$9,840.00 |
| Rate for Payer: Adventist Health Commercial |
$2,624.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,449.28
|
| Rate for Payer: Cash Price |
$5,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,882.24
|
| Rate for Payer: Heritage Provider Network Senior |
$8,882.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,374.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,280.00
|
| Rate for Payer: Multiplan Commercial |
$9,840.00
|
|
|
HC REP INT WNDS 7.6-12.5CM
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.27 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Adventist Health Commercial |
$201.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$648.51
|
| Rate for Payer: Cash Price |
$453.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$681.74
|
| Rate for Payer: Heritage Provider Network Senior |
$681.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.75
|
| Rate for Payer: Multiplan Commercial |
$755.25
|
|
|
HC REP INT WNDS 7.6-12.5CM
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.27 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$201.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$622.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$478.32
|
| Rate for Payer: Blue Shield of California EPN |
$380.65
|
| Rate for Payer: Cash Price |
$453.15
|
| Rate for Payer: Cash Price |
$453.15
|
| Rate for Payer: Cash Price |
$453.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$654.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$950.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$681.74
|
| Rate for Payer: Heritage Provider Network Senior |
$681.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$480.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$755.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: TriValley Medical Group Commercial |
$604.20
|
| Rate for Payer: TriValley Medical Group Senior |
$604.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
IP
|
$1,446.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$261.73 |
| Max. Negotiated Rate |
$1,084.50 |
| Rate for Payer: Adventist Health Commercial |
$289.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$931.22
|
| Rate for Payer: Cash Price |
$650.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$978.94
|
| Rate for Payer: Heritage Provider Network Senior |
$978.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.50
|
| Rate for Payer: Multiplan Commercial |
$1,084.50
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
OP
|
$1,446.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$261.73 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$289.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$893.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$686.85
|
| Rate for Payer: Blue Shield of California EPN |
$546.59
|
| Rate for Payer: Cash Price |
$650.70
|
| Rate for Payer: Cash Price |
$650.70
|
| Rate for Payer: Cash Price |
$650.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$939.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$522.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$978.94
|
| Rate for Payer: Heritage Provider Network Senior |
$978.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$689.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$261.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,084.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: TriValley Medical Group Commercial |
$867.60
|
| Rate for Payer: TriValley Medical Group Senior |
$867.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC REPLACE DUODENAL/JEJUN TUBE
|
Facility
|
OP
|
$4,472.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$809.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$894.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,763.70
|
| 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 |
$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 |
$2,012.40
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,906.80
|
| 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 |
$2,768.17
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,216.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$809.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,118.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$3,354.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,283.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1,283.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 REPLACE DUODENAL/JEJUN TUBE
|
Facility
|
IP
|
$4,472.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$809.43 |
| Max. Negotiated Rate |
$3,354.00 |
| Rate for Payer: Adventist Health Commercial |
$894.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,879.97
|
| Rate for Payer: Cash Price |
$2,012.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,027.54
|
| Rate for Payer: Heritage Provider Network Senior |
$3,027.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$809.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,118.00
|
| Rate for Payer: Multiplan Commercial |
$3,354.00
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
OP
|
$2,016.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$364.90 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$403.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,245.89
|
| 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 |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$957.60
|
| Rate for Payer: Blue Shield of California EPN |
$762.05
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,310.40
|
| 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 |
$1,364.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,364.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$961.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$1,512.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,209.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,209.60
|
| 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 REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
IP
|
$2,016.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$364.90 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: Adventist Health Commercial |
$403.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,298.30
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,364.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,364.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$1,512.00
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
OP
|
$2,016.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$364.90 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$403.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,245.89
|
| 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 |
$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 |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,310.40
|
| 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 |
$1,247.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,216.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$1,512.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,283.18
|
| Rate for Payer: TriValley Medical Group Senior |
$1,283.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 REPLACE GAST/CECOSTOMY TUBE
|
Facility
|
IP
|
$2,016.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$364.90 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: Adventist Health Commercial |
$403.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,298.30
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,364.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,364.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$1,512.00
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$2,861.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$517.84 |
| Max. Negotiated Rate |
$2,145.75 |
| Rate for Payer: Adventist Health Commercial |
$572.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,842.48
|
| Rate for Payer: Cash Price |
$1,287.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,936.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,936.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$517.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.25
|
| Rate for Payer: Multiplan Commercial |
$2,145.75
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$2,861.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$572.20
|
| Rate for Payer: Adventist Health Commercial |
$564.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,745.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,768.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| 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 Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,287.45
|
| Rate for Payer: Cash Price |
$1,287.45
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$1,287.45
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,835.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,859.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| 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 Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| 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 Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,770.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,748.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,434.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,347.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,364.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$517.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$511.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,145.75
|
| Rate for Payer: Multiplan Commercial |
$2,118.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| 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 Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
IP
|
$2,861.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$517.84 |
| Max. Negotiated Rate |
$2,145.75 |
| Rate for Payer: Adventist Health Commercial |
$572.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,842.48
|
| Rate for Payer: Cash Price |
$1,287.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,936.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,936.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$517.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.25
|
| Rate for Payer: Multiplan Commercial |
$2,145.75
|
|
|
HC REPLACE G-J TUBE PERC
|
Facility
|
OP
|
$2,824.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
906749452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$511.14 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,067.47
|
| Rate for Payer: Adventist Health Commercial |
$564.80
|
| Rate for Payer: Adventist Health Commercial |
$572.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,768.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,745.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| 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 Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,341.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,358.97
|
| Rate for Payer: Blue Shield of California EPN |
$1,081.46
|
| Rate for Payer: Cash Price |
$1,287.45
|
| Rate for Payer: Cash Price |
$1,287.45
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$1,287.45
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cash Price |
$1,270.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,835.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,859.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| 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 Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| 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 Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,166.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,936.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,911.85
|
| Rate for Payer: Heritage Provider Network Senior |
$1,936.90
|
| Rate for Payer: Heritage Provider Network Senior |
$1,911.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,364.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,347.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$517.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$511.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$715.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,145.75
|
| Rate for Payer: Multiplan Commercial |
$2,118.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,694.40
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,716.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,716.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,694.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| 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 Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC REPLACE PORT THRU SAME ACCESS
|
Facility
|
IP
|
$10,912.00
|
|
|
Service Code
|
CPT 36585
|
| Hospital Charge Code |
909020012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,975.07 |
| Max. Negotiated Rate |
$8,184.00 |
| Rate for Payer: Adventist Health Commercial |
$2,182.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,027.33
|
| Rate for Payer: Cash Price |
$4,910.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,387.42
|
| Rate for Payer: Heritage Provider Network Senior |
$7,387.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,975.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,728.00
|
| Rate for Payer: Multiplan Commercial |
$8,184.00
|
|
|
HC REPLACE PORT THRU SAME ACCESS
|
Facility
|
OP
|
$10,912.00
|
|
|
Service Code
|
CPT 36585
|
| Hospital Charge Code |
909020012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,975.07 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$2,182.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,743.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$4,910.40
|
| Rate for Payer: Cash Price |
$4,910.40
|
| Rate for Payer: Cash Price |
$4,910.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,092.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,754.53
|
| Rate for Payer: Heritage Provider Network Senior |
$4,995.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,715.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,975.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,728.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$8,184.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,467.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4,467.15
|
| 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 |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
IP
|
$19,892.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,600.45 |
| Max. Negotiated Rate |
$14,919.00 |
| Rate for Payer: Adventist Health Commercial |
$3,978.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,810.45
|
| Rate for Payer: Cash Price |
$8,951.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,466.88
|
| Rate for Payer: Heritage Provider Network Senior |
$13,466.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,600.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,973.00
|
| Rate for Payer: Multiplan Commercial |
$14,919.00
|
|
|
HC REPLACE/REVISION/SHUNT SYSTEM
|
Facility
|
OP
|
$19,892.00
|
|
|
Service Code
|
CPT 62230
|
| Hospital Charge Code |
900501521
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,600.45 |
| Max. Negotiated Rate |
$16,930.81 |
| Rate for Payer: Adventist Health Commercial |
$3,978.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,293.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,287.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,448.70
|
| Rate for Payer: Blue Shield of California EPN |
$7,519.18
|
| Rate for Payer: Cash Price |
$8,951.40
|
| Rate for Payer: Cash Price |
$8,951.40
|
| Rate for Payer: Cash Price |
$8,951.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$12,929.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,415.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,287.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,929.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$11,287.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,466.88
|
| Rate for Payer: Heritage Provider Network Senior |
$13,466.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$9,488.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,600.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,980.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,973.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,124.86
|
| Rate for Payer: Multiplan Commercial |
$14,919.00
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,935.20
|
| Rate for Payer: TriValley Medical Group Senior |
$11,935.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11,287.21
|
|
|
HC REPLACE TUNNELED CV CATH
|
Facility
|
IP
|
$12,708.00
|
|
|
Service Code
|
CPT 36582
|
| Hospital Charge Code |
909081841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,300.15 |
| Max. Negotiated Rate |
$9,531.00 |
| Rate for Payer: Adventist Health Commercial |
$2,541.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,183.95
|
| Rate for Payer: Cash Price |
$5,718.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,603.32
|
| Rate for Payer: Heritage Provider Network Senior |
$8,603.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,300.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,177.00
|
| Rate for Payer: Multiplan Commercial |
$9,531.00
|
|
