|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
OP
|
$8,080.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906820335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$688.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,616.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,550.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,252.00
|
| 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 |
$5,001.52
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$688.24
|
| Rate for Payer: Inland Empire Health Plan (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 |
$1,462.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,020.00
|
| 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 |
$6,060.00
|
| 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 TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
OP
|
$6,853.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$688.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,370.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,708.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,651.80
|
| Rate for Payer: Blue Shield of California EPN |
$5,716.91
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,454.45
|
| 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 |
$4,242.01
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$688.24
|
| Rate for Payer: Inland Empire Health Plan (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 |
$1,240.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,713.25
|
| 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 |
$5,139.75
|
| 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 TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
IP
|
$8,080.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906820335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,462.48 |
| Max. Negotiated Rate |
$6,060.00 |
| Rate for Payer: Adventist Health Commercial |
$1,616.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,550.96
|
| Rate for Payer: Cash Price |
$3,636.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,470.16
|
| Rate for Payer: Heritage Provider Network Senior |
$5,470.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,462.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,020.00
|
| Rate for Payer: Multiplan Commercial |
$6,060.00
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
IP
|
$6,853.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,240.39 |
| Max. Negotiated Rate |
$5,139.75 |
| Rate for Payer: Adventist Health Commercial |
$1,370.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,708.01
|
| Rate for Payer: Cash Price |
$3,083.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,639.48
|
| Rate for Payer: Heritage Provider Network Senior |
$4,639.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,240.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,713.25
|
| Rate for Payer: Multiplan Commercial |
$5,139.75
|
|
|
HC TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
IP
|
$62.19
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$46.64 |
| Rate for Payer: Adventist Health Commercial |
$12.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.72
|
| Rate for Payer: Cash Price |
$27.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.10
|
| Rate for Payer: Heritage Provider Network Senior |
$42.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.55
|
| Rate for Payer: Multiplan Commercial |
$46.64
|
|
|
HC TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
OP
|
$62.19
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Adventist Health Commercial |
$12.44
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,756.00
|
| Rate for Payer: Cash Price |
$27.99
|
| Rate for Payer: Cash Price |
$27.99
|
| Rate for Payer: Cash Price |
$27.99
|
| Rate for Payer: Cigna of CA HMO/PPO |
$40.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.86
|
| Rate for Payer: Dignity Health Senior |
$52.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.10
|
| Rate for Payer: Heritage Provider Network Senior |
$42.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$29.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.55
|
| Rate for Payer: Multiplan Commercial |
$46.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$22.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$20.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.86
|
| Rate for Payer: Vantage Medical Group Senior |
$52.86
|
|
|
HC TEAR DUCT(LACRIM)SCN
|
Facility
|
IP
|
$847.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$153.31 |
| Max. Negotiated Rate |
$635.25 |
| Rate for Payer: Adventist Health Commercial |
$169.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$581.89
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.42
|
| Rate for Payer: Heritage Provider Network Senior |
$573.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.75
|
| Rate for Payer: Multiplan Commercial |
$635.25
|
|
|
HC TEAR DUCT(LACRIM)SCN
|
Facility
|
OP
|
$847.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$979.11 |
| Rate for Payer: Adventist Health Commercial |
$169.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$333.59
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$581.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$432.59
|
| Rate for Payer: Blue Shield of California EPN |
$246.00
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$550.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$550.55
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$524.29
|
| Rate for Payer: Heritage Provider Network Senior |
$524.29
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$134.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$635.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC TEGADERM
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
909081239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8.07
|
| Rate for Payer: Blue Shield of California EPN |
$7.63
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.05
|
| Rate for Payer: Dignity Health Senior |
$11.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11.05
|
|
|
HC TEGADERM
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
909081239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8.93
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
|
|
HC TEG-MEYER CANNULATOR
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
909001097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Blue Shield of California Commercial |
$50.92
|
| Rate for Payer: Blue Shield of California EPN |
$48.13
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$53.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Senior |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Senior |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$39.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC TEG-MEYER CANNULATOR
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
909001097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$56.33
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$55.51
|
| Rate for Payer: Heritage Provider Network Senior |
$55.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
|
|
HC TEMP CLOSURE/EYELIDS BY SUTURE
|
Facility
|
OP
|
$1,991.00
|
|
|
Service Code
|
CPT 67875
|
| Hospital Charge Code |
900501425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$360.37 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$398.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,367.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,264.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$895.95
|
| Rate for Payer: Cash Price |
$895.95
|
| Rate for Payer: Cash Price |
$895.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,294.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.47
|
| Rate for Payer: Dignity Health Senior |
$1,264.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,294.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,264.97
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,347.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,347.91
|
| Rate for Payer: Humana Medicare |
$1,264.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,264.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$959.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,492.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,593.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,593.86
|
| Rate for Payer: Multiplan Commercial |
$1,493.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$722.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$665.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.97
|
|
|
HC TEMP CLOSURE/EYELIDS BY SUTURE
|
Facility
|
IP
|
$1,991.00
|
|
|
Service Code
|
CPT 67875
|
| Hospital Charge Code |
900501425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$360.37 |
| Max. Negotiated Rate |
$1,493.25 |
| Rate for Payer: Adventist Health Commercial |
$398.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,367.82
|
| Rate for Payer: Cash Price |
$895.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,347.91
|
| Rate for Payer: Heritage Provider Network Senior |
$1,347.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.75
|
| Rate for Payer: Multiplan Commercial |
$1,493.25
|
|
|
HC TEMP INSERT LEAD PCMKR DUAL
|
Facility
|
OP
|
$13,451.00
|
|
|
Service Code
|
CPT 33211
|
| Hospital Charge Code |
906811356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$15,922.18 |
| Rate for Payer: Adventist Health Commercial |
$2,690.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,240.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$6,052.95
|
| Rate for Payer: Cash Price |
$6,052.95
|
| Rate for Payer: Cash Price |
$6,052.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,743.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: Dignity Health Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,614.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,106.33
|
| Rate for Payer: Heritage Provider Network Senior |
$9,106.33
|
| Rate for Payer: Humana Medicare |
$10,614.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,483.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,434.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,525.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,362.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,374.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,374.64
|
| Rate for Payer: Multiplan Commercial |
$10,088.25
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,884.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,493.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC TEMP INSERT LEAD PCMKR DUAL
|
Facility
|
IP
|
$15,412.00
|
|
|
Service Code
|
CPT 33211
|
| Hospital Charge Code |
906820054
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,789.57 |
| Max. Negotiated Rate |
$11,559.00 |
| Rate for Payer: Adventist Health Commercial |
$3,082.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,588.04
|
| Rate for Payer: Cash Price |
$6,935.40
|
| Rate for Payer: Cash Price |
$6,935.40
|
| 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 |
$2,789.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,853.00
|
| Rate for Payer: Multiplan Commercial |
$11,559.00
|
|
|
HC TEMP INSERT LEAD PCMKR DUAL
|
Facility
|
OP
|
$15,412.00
|
|
|
Service Code
|
CPT 33211
|
| Hospital Charge Code |
906820054
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$273.55 |
| Max. Negotiated Rate |
$20,168.10 |
| Rate for Payer: Adventist Health Commercial |
$3,082.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,588.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$6,935.40
|
| Rate for Payer: Cash Price |
$6,935.40
|
| Rate for Payer: Cash Price |
$6,935.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: Dignity Health Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,614.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,540.03
|
| Rate for Payer: Heritage Provider Network Senior |
$13,056.19
|
| Rate for Payer: Humana Medicare |
$10,614.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$273.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20,168.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,789.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,525.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,853.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,374.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,374.64
|
| Rate for Payer: Multiplan Commercial |
$11,559.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,676.27
|
| Rate for Payer: TriValley Medical Group Senior |
$10,614.79
|
| 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 |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC TEMP INSERT LEAD PCMKR DUAL
|
Facility
|
IP
|
$13,451.00
|
|
|
Service Code
|
CPT 33211
|
| Hospital Charge Code |
906811356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,434.63 |
| Max. Negotiated Rate |
$10,088.25 |
| Rate for Payer: Adventist Health Commercial |
$2,690.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,240.84
|
| Rate for Payer: Cash Price |
$6,052.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,106.33
|
| Rate for Payer: Heritage Provider Network Senior |
$9,106.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,434.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,362.75
|
| Rate for Payer: Multiplan Commercial |
$10,088.25
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
OP
|
$13,451.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906811309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$406.55 |
| Max. Negotiated Rate |
$20,168.10 |
| Rate for Payer: Adventist Health Commercial |
$2,690.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,240.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$6,052.95
|
| Rate for Payer: Cash Price |
$6,052.95
|
| Rate for Payer: Cash Price |
$6,052.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,743.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: Dignity Health Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,614.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,326.17
|
| Rate for Payer: Heritage Provider Network Senior |
$13,056.19
|
| Rate for Payer: Humana Medicare |
$10,614.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$406.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20,168.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,434.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,525.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,362.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,374.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,374.64
|
| Rate for Payer: Multiplan Commercial |
$10,088.25
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,676.27
|
| Rate for Payer: TriValley Medical Group Senior |
$11,676.27
|
| 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 |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
IP
|
$13,451.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906811309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,434.63 |
| Max. Negotiated Rate |
$10,088.25 |
| Rate for Payer: Adventist Health Commercial |
$2,690.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,240.84
|
| Rate for Payer: Cash Price |
$6,052.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,106.33
|
| Rate for Payer: Heritage Provider Network Senior |
$9,106.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,434.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,362.75
|
| Rate for Payer: Multiplan Commercial |
$10,088.25
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
OP
|
$13,451.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906811309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$15,922.18 |
| Rate for Payer: Adventist Health Commercial |
$2,690.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,240.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$6,052.95
|
| Rate for Payer: Cash Price |
$6,052.95
|
| Rate for Payer: Cash Price |
$6,052.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,743.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: Dignity Health Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,614.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,106.33
|
| Rate for Payer: Heritage Provider Network Senior |
$9,106.33
|
| Rate for Payer: Humana Medicare |
$10,614.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,483.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,434.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,525.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,362.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,374.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,374.64
|
| Rate for Payer: Multiplan Commercial |
$10,088.25
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,884.06
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,493.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
IP
|
$14,678.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906820103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,656.72 |
| Max. Negotiated Rate |
$11,008.50 |
| Rate for Payer: Adventist Health Commercial |
$2,935.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,083.79
|
| Rate for Payer: Cash Price |
$6,605.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,937.01
|
| Rate for Payer: Heritage Provider Network Senior |
$9,937.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,656.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,669.50
|
| Rate for Payer: Multiplan Commercial |
$11,008.50
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
IP
|
$13,451.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906811309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,434.63 |
| Max. Negotiated Rate |
$10,088.25 |
| Rate for Payer: Adventist Health Commercial |
$2,690.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,240.84
|
| Rate for Payer: Cash Price |
$6,052.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,106.33
|
| Rate for Payer: Heritage Provider Network Senior |
$9,106.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,434.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,362.75
|
| Rate for Payer: Multiplan Commercial |
$10,088.25
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
OP
|
$14,678.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906820103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$406.55 |
| Max. Negotiated Rate |
$20,168.10 |
| Rate for Payer: Adventist Health Commercial |
$2,935.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,083.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,614.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,131.19
|
| Rate for Payer: Blue Shield of California EPN |
$12,145.11
|
| Rate for Payer: Cash Price |
$6,605.10
|
| Rate for Payer: Cash Price |
$6,605.10
|
| Rate for Payer: Cash Price |
$6,605.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,540.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,922.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,676.27
|
| Rate for Payer: Dignity Health Senior |
$10,614.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,614.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,085.68
|
| Rate for Payer: Heritage Provider Network Senior |
$13,056.19
|
| Rate for Payer: Humana Medicare |
$10,614.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$406.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,614.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$20,168.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,656.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,525.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,669.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,374.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,374.64
|
| Rate for Payer: Multiplan Commercial |
$11,008.50
|
| Rate for Payer: Multiplan WC |
$14,511.92
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,676.27
|
| Rate for Payer: TriValley Medical Group Senior |
$11,676.27
|
| 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 |
$15,922.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,676.27
|
| Rate for Payer: Vantage Medical Group Senior |
$10,614.79
|
|
|
HC TEMP TRANSCUTANEOUS PACING
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
906811141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$323.99 |
| Max. Negotiated Rate |
$1,342.50 |
| Rate for Payer: Adventist Health Commercial |
$358.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,229.73
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,211.83
|
| Rate for Payer: Heritage Provider Network Senior |
$1,211.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$323.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$447.50
|
| Rate for Payer: Multiplan Commercial |
$1,342.50
|
|
