|
HC REVISION GASTRODUO WO VAGOTOMY
|
Facility
|
IP
|
$10,218.00
|
|
|
Service Code
|
CPT 43850
|
| Hospital Charge Code |
906743850
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,849.46 |
| Max. Negotiated Rate |
$7,663.50 |
| Rate for Payer: Adventist Health Commercial |
$2,043.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,580.39
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,917.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6,917.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,849.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.50
|
| Rate for Payer: Multiplan Commercial |
$7,663.50
|
|
|
HC REVISION GASTRODUO WO VAGOTOMY
|
Facility
|
OP
|
$10,218.00
|
|
|
Service Code
|
CPT 43850
|
| Hospital Charge Code |
906743850
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,728.00 |
| Rate for Payer: Adventist Health Commercial |
$2,043.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,314.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,619.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,663.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,641.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,685.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,685.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,324.94
|
| Rate for Payer: Heritage Provider Network Senior |
$6,324.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,873.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,849.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,152.60
|
| Rate for Payer: Multiplan Commercial |
$7,663.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,109.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,109.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,685.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8,685.30
|
|
|
HC REVISION GASTRODUO W VAGOTOMY
|
Facility
|
IP
|
$10,218.00
|
|
|
Service Code
|
CPT 43855
|
| Hospital Charge Code |
906743855
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,849.46 |
| Max. Negotiated Rate |
$7,663.50 |
| Rate for Payer: Adventist Health Commercial |
$2,043.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,580.39
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,917.59
|
| Rate for Payer: Heritage Provider Network Senior |
$6,917.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,849.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.50
|
| Rate for Payer: Multiplan Commercial |
$7,663.50
|
|
|
HC REVISION GASTRODUO W VAGOTOMY
|
Facility
|
OP
|
$10,218.00
|
|
|
Service Code
|
CPT 43855
|
| Hospital Charge Code |
906743855
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,728.00 |
| Rate for Payer: Adventist Health Commercial |
$2,043.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,314.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,619.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,663.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Cash Price |
$4,598.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,641.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,685.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,685.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,324.94
|
| Rate for Payer: Heritage Provider Network Senior |
$6,324.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,873.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,849.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,554.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,152.60
|
| Rate for Payer: Multiplan Commercial |
$7,663.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,109.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,109.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,685.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,685.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8,685.30
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$41,423.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,497.56 |
| Max. Negotiated Rate |
$31,067.25 |
| Rate for Payer: Adventist Health Commercial |
$8,284.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$26,676.41
|
| Rate for Payer: Cash Price |
$18,640.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,043.37
|
| Rate for Payer: Heritage Provider Network Senior |
$28,043.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,497.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,355.75
|
| Rate for Payer: Multiplan Commercial |
$31,067.25
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$41,423.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$31,067.25 |
| Rate for Payer: Adventist Health Commercial |
$8,284.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$25,599.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,320.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$18,640.35
|
| Rate for Payer: Cash Price |
$18,640.35
|
| Rate for Payer: Cash Price |
$18,640.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$26,924.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,052.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,320.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,320.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$25,640.84
|
| Rate for Payer: Heritage Provider Network Senior |
$9,003.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,320.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13,908.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,497.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,418.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,355.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,809.20
|
| Rate for Payer: Multiplan Commercial |
$31,067.25
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,052.33
|
| Rate for Payer: TriValley Medical Group Senior |
$8,052.33
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,980.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,052.33
|
| Rate for Payer: Vantage Medical Group Senior |
$7,320.30
|
|
|
HC REVISION OF EYELID
|
Facility
|
OP
|
$3,246.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.24 |
| Max. Negotiated Rate |
$2,434.50 |
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Adventist Health Commercial |
$649.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,006.03
|
| 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 |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,541.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,226.99
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$2,109.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$408.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,197.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,197.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,548.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$587.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$811.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$2,434.50
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,947.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,947.60
|
| 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 REVISION OF EYELID
|
Facility
|
IP
|
$3,246.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$587.53 |
| Max. Negotiated Rate |
$2,434.50 |
| Rate for Payer: Adventist Health Commercial |
$649.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,090.42
|
| Rate for Payer: Cash Price |
$1,460.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,197.54
|
| Rate for Payer: Heritage Provider Network Senior |
$2,197.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$587.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$811.50
|
| Rate for Payer: Multiplan Commercial |
$2,434.50
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
IP
|
$51,245.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,275.34 |
| Max. Negotiated Rate |
$38,433.75 |
| Rate for Payer: Adventist Health Commercial |
$10,249.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,001.78
|
| Rate for Payer: Cash Price |
$23,060.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$34,692.86
|
| Rate for Payer: Heritage Provider Network Senior |
$34,692.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,275.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,811.25
|
| Rate for Payer: Multiplan Commercial |
$38,433.75
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
OP
|
$51,245.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$44,797.35 |
| Rate for Payer: Adventist Health Commercial |
$10,249.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31,669.41
|
| 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 |
$9,136.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$23,060.25
|
| Rate for Payer: Cash Price |
$23,060.25
|
| Rate for Payer: Cash Price |
$23,060.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$33,309.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$30,747.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$23,577.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$31,720.65
|
| 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 |
$9,275.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,114.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12,811.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$38,433.75
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$25,935.31
|
| Rate for Payer: TriValley Medical Group Senior |
$25,935.31
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$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 RF ABL NRV NRVTG SJ W/IG
|
Facility
|
IP
|
$5,229.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$946.45 |
| Max. Negotiated Rate |
$3,921.75 |
| Rate for Payer: Adventist Health Commercial |
$1,045.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,367.48
|
| Rate for Payer: Cash Price |
$2,353.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,540.03
|
| Rate for Payer: Heritage Provider Network Senior |
$3,540.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$946.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,307.25
|
| Rate for Payer: Multiplan Commercial |
$3,921.75
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
OP
|
$5,229.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$946.45 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,045.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,231.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| 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 |
$2,353.05
|
| Rate for Payer: Cash Price |
$2,353.05
|
| Rate for Payer: Cash Price |
$2,353.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,398.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,511.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,236.75
|
| Rate for Payer: Heritage Provider Network Senior |
$3,089.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,771.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$946.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,888.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,307.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$3,921.75
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,762.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,762.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
OP
|
$4,220.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$763.82 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$844.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,607.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,587.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,321.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,165.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,743.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,587.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,587.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,587.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,532.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,612.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,012.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$763.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,954.00
|
| Rate for Payer: Multiplan Commercial |
$3,165.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,587.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,587.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,587.00
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
IP
|
$4,220.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$763.82 |
| Max. Negotiated Rate |
$3,165.00 |
| Rate for Payer: Adventist Health Commercial |
$844.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,717.68
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,856.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2,856.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$763.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.00
|
| Rate for Payer: Multiplan Commercial |
$3,165.00
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
IP
|
$4,220.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$763.82 |
| Max. Negotiated Rate |
$3,165.00 |
| Rate for Payer: Adventist Health Commercial |
$844.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,717.68
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,856.94
|
| Rate for Payer: Heritage Provider Network Senior |
$2,856.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$763.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.00
|
| Rate for Payer: Multiplan Commercial |
$3,165.00
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
OP
|
$4,220.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$763.82 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$844.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,607.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,587.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,321.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,165.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cash Price |
$1,899.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,743.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,587.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,587.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,587.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,532.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,612.18
|
| Rate for Payer: Heritage Provider Network Senior |
$2,612.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,012.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$763.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,954.00
|
| Rate for Payer: Multiplan Commercial |
$3,165.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,587.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,587.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,587.00
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,631.65
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,868.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,868.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,444.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,674.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,315.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,511.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,451.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,089.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,771.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,301.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,888.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,762.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,762.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$5,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,631.65
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,868.98
|
| Rate for Payer: Heritage Provider Network Senior |
$4,868.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.75 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,444.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cash Price |
$3,236.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,674.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,315.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,511.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,451.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,089.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,771.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,301.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,888.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,762.68
|
| Rate for Payer: TriValley Medical Group Senior |
$2,762.68
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7,454.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,273.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC RF MAGNETIC-GUIDE AV FISTULA
|
Facility
|
IP
|
$21,414.00
|
|
|
Service Code
|
CPT G2171
|
| Hospital Charge Code |
909000755
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,875.93 |
| Max. Negotiated Rate |
$16,060.50 |
| Rate for Payer: Adventist Health Commercial |
$4,282.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,790.62
|
| Rate for Payer: Cash Price |
$9,636.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,497.28
|
| Rate for Payer: Heritage Provider Network Senior |
$14,497.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,875.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,353.50
|
| Rate for Payer: Multiplan Commercial |
$16,060.50
|
|
|
HC RF MAGNETIC-GUIDE AV FISTULA
|
Facility
|
OP
|
$21,414.00
|
|
|
Service Code
|
CPT G2171
|
| Hospital Charge Code |
909000755
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,875.93 |
| Max. Negotiated Rate |
$18,201.90 |
| Rate for Payer: Adventist Health Commercial |
$4,282.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13,233.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,201.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,777.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,060.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$9,636.30
|
| Rate for Payer: Cash Price |
$9,636.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13,919.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,201.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,201.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,848.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,255.27
|
| Rate for Payer: Heritage Provider Network Senior |
$13,255.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$10,214.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,875.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,353.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,989.80
|
| Rate for Payer: Multiplan Commercial |
$16,060.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,707.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10,707.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,201.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,201.90
|
| Rate for Payer: Vantage Medical Group Senior |
$18,201.90
|
|
|
HC RHABDOMYOSARCOMABY RT-PCR
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
903800239
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$61.18 |
| Max. Negotiated Rate |
$253.50 |
| Rate for Payer: Adventist Health Commercial |
$67.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$217.67
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$228.83
|
| Rate for Payer: Heritage Provider Network Senior |
$228.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.50
|
| Rate for Payer: Multiplan Commercial |
$253.50
|
|
|
HC RHABDOMYOSARCOMABY RT-PCR
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
903800239
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$61.18 |
| Max. Negotiated Rate |
$300.43 |
| Rate for Payer: Adventist Health Commercial |
$67.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$208.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.43
|
| Rate for Payer: Blue Shield of California Commercial |
$206.18
|
| Rate for Payer: Blue Shield of California EPN |
$164.94
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cash Price |
$152.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$219.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$209.22
|
| Rate for Payer: Heritage Provider Network Senior |
$209.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$161.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$157.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$253.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.00
|
| Rate for Payer: TriValley Medical Group Senior |
$137.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$147.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC RH BLOOD GROUP
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
900904622
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$75.35
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.21
|
| Rate for Payer: Heritage Provider Network Senior |
$79.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
|
