|
HC TEMP INSERT LEAD PCMKR DUAL
|
Facility
|
IP
|
$11,480.00
|
|
|
Service Code
|
CPT 33211
|
| Hospital Charge Code |
906811356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,077.88 |
| Max. Negotiated Rate |
$8,610.00 |
| Rate for Payer: Adventist Health Commercial |
$2,296.00
|
| Rate for Payer: Cash Price |
$6,314.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,771.96
|
| Rate for Payer: Heritage Provider Network Senior |
$7,771.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,077.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,870.00
|
| Rate for Payer: Multiplan Commercial |
$8,610.00
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
IP
|
$11,852.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906811309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,145.21 |
| Max. Negotiated Rate |
$8,889.00 |
| Rate for Payer: Adventist Health Commercial |
$2,370.40
|
| Rate for Payer: Cash Price |
$6,518.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,023.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8,023.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,145.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,963.00
|
| Rate for Payer: Multiplan Commercial |
$8,889.00
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
OP
|
$11,852.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906811309
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19,979.37 |
| Rate for Payer: Adventist Health Commercial |
$2,370.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,142.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$6,518.60
|
| Rate for Payer: Cash Price |
$6,518.60
|
| Rate for Payer: Cash Price |
$6,518.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,703.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Senior |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,515.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,336.39
|
| Rate for Payer: Heritage Provider Network Senior |
$12,934.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$422.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19,979.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,145.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,092.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,963.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,249.48
|
| Rate for Payer: Multiplan Commercial |
$8,889.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,567.01
|
| Rate for Payer: TriValley Medical Group Senior |
$11,567.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
OP
|
$11,852.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906811309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$16,754.51 |
| Rate for Payer: Adventist Health Commercial |
$2,370.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,142.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$6,518.60
|
| Rate for Payer: Cash Price |
$6,518.60
|
| Rate for Payer: Cash Price |
$6,518.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,703.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Senior |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,515.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,023.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8,023.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,653.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,145.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,092.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,963.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,249.48
|
| Rate for Payer: Multiplan Commercial |
$8,889.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,264.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,924.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
IP
|
$11,852.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906811309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,145.21 |
| Max. Negotiated Rate |
$8,889.00 |
| Rate for Payer: Adventist Health Commercial |
$2,370.40
|
| Rate for Payer: Cash Price |
$6,518.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,023.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8,023.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,145.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,963.00
|
| Rate for Payer: Multiplan Commercial |
$8,889.00
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
IP
|
$13,944.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906820103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,523.86 |
| Max. Negotiated Rate |
$10,458.00 |
| Rate for Payer: Adventist Health Commercial |
$2,788.80
|
| Rate for Payer: Cash Price |
$7,669.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,440.09
|
| Rate for Payer: Heritage Provider Network Senior |
$9,440.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,523.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,486.00
|
| Rate for Payer: Multiplan Commercial |
$10,458.00
|
|
|
HC TEMP INSERT LEAD PCMKR SNGL
|
Facility
|
OP
|
$13,944.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
906820103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$19,979.37 |
| Rate for Payer: Adventist Health Commercial |
$2,788.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,579.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,515.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,574.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,673.59
|
| Rate for Payer: Cash Price |
$7,669.20
|
| Rate for Payer: Cash Price |
$7,669.20
|
| Rate for Payer: Cash Price |
$7,669.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,063.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,567.01
|
| Rate for Payer: Dignity Health Senior |
$10,515.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,515.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,631.34
|
| Rate for Payer: Heritage Provider Network Senior |
$12,934.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$422.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,515.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$19,979.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,523.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,092.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,249.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,249.48
|
| Rate for Payer: Multiplan Commercial |
$10,458.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,567.01
|
| Rate for Payer: TriValley Medical Group Senior |
$11,567.01
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,773.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,567.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10,515.46
|
|
|
HC TEMP TRANSCUTANEOUS PACING
|
Facility
|
IP
|
$1,955.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
906811141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$353.86 |
| Max. Negotiated Rate |
$1,466.25 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Cash Price |
$1,075.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,323.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,323.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.75
|
| Rate for Payer: Multiplan Commercial |
$1,466.25
|
|
|
HC TEMP TRANSCUTANEOUS PACING
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
906811141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,044.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,343.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$831.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| 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 |
$1,075.25
|
| Rate for Payer: Cash Price |
$1,075.25
|
| Rate for Payer: Cash Price |
$1,075.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$914.61
|
| Rate for Payer: Dignity Health Senior |
$831.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,270.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$831.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,210.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,022.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$831.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,579.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,047.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,047.64
|
| Rate for Payer: Multiplan Commercial |
$1,466.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$914.61
|
| Rate for Payer: TriValley Medical Group Senior |
$831.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Vantage Medical Group Senior |
$831.46
|
|
|
HC TEMP TRANSCUTANEOUS PACING
|
Facility
|
IP
|
$1,955.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
906811141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$353.86 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Cash Price |
$1,075.25
|
| Rate for Payer: Cash Price |
$1,075.25
|
| 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 |
$353.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.75
|
| Rate for Payer: Multiplan Commercial |
$1,466.25
|
|
|
HC TEMP TRANSCUTANEOUS PACING
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
906811141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$353.86 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,044.95
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,343.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$831.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$1,075.25
|
| Rate for Payer: Cash Price |
$1,075.25
|
| Rate for Payer: Cash Price |
$1,075.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,270.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$914.61
|
| Rate for Payer: Dignity Health Senior |
$831.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,270.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$831.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,323.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,323.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$831.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$932.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,047.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,047.64
|
| Rate for Payer: Multiplan Commercial |
$1,466.25
|
| Rate for Payer: Multiplan WC |
$1,324.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$703.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$647.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Vantage Medical Group Senior |
$831.46
|
|
|
HC TENOTOMY PERCUT TOE SNGL TENDN
|
Facility
|
IP
|
$5,100.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
900501072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$923.10 |
| Max. Negotiated Rate |
$3,825.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,452.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,452.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
|
|
HC TENOTOMY PERCUT TOE SNGL TENDN
|
Facility
|
OP
|
$5,100.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
900501072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,503.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,315.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Senior |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,033.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,452.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,452.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,432.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.18
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,834.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,688.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC TERUMO TR BAND COMPRESSOR
|
Facility
|
OP
|
$319.00
|
|
| Hospital Charge Code |
906812391
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$271.15 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$170.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$219.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$271.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.25
|
| Rate for Payer: Blue Shield of California Commercial |
$194.59
|
| Rate for Payer: Blue Shield of California EPN |
$155.67
|
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$207.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$271.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.15
|
| Rate for Payer: Dignity Health Senior |
$271.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$197.46
|
| Rate for Payer: Heritage Provider Network Senior |
$197.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$152.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$223.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$223.30
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$159.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$159.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$271.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.15
|
| Rate for Payer: Vantage Medical Group Senior |
$271.15
|
|
|
HC TERUMO TR BAND COMPRESSOR
|
Facility
|
IP
|
$319.00
|
|
| Hospital Charge Code |
906812391
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Adventist Health Commercial |
$63.80
|
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.96
|
| Rate for Payer: Heritage Provider Network Senior |
$215.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
|
|
HC TESTICULAR SCAN
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Cash Price |
$581.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$715.59
|
| Rate for Payer: Heritage Provider Network Senior |
$715.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
|
|
HC TESTICULAR SCAN
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$792.75 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$564.97
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$726.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Blue Shield of California Commercial |
$672.96
|
| Rate for Payer: Blue Shield of California EPN |
$541.17
|
| Rate for Payer: Cash Price |
$581.35
|
| Rate for Payer: Cash Price |
$581.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$687.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Senior |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$510.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$654.28
|
| Rate for Payer: Heritage Provider Network Senior |
$654.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$140.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$504.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.32
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$561.63
|
| Rate for Payer: TriValley Medical Group Senior |
$510.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$528.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$528.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$162.48
|
| Rate for Payer: Heritage Provider Network Senior |
$162.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$235.65 |
| Rate for Payer: Adventist Health Commercial |
$48.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$128.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.65
|
| Rate for Payer: Blue Shield of California Commercial |
$207.82
|
| Rate for Payer: Blue Shield of California EPN |
$166.69
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$156.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Senior |
$25.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$25.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.56
|
| Rate for Payer: Heritage Provider Network Senior |
$148.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$114.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$25.81
|
| Rate for Payer: TriValley Medical Group Senior |
$25.81
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$27.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$27.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC TEST URINE VOLUME
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
900910797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$54.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$70.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.23
|
| Rate for Payer: Blue Shield of California Commercial |
$24.13
|
| Rate for Payer: Blue Shield of California EPN |
$19.36
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$66.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.00
|
| Rate for Payer: Dignity Health Senior |
$3.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$3.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.14
|
| Rate for Payer: Heritage Provider Network Senior |
$63.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$48.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.59
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$3.64
|
| Rate for Payer: TriValley Medical Group Senior |
$3.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3.64
|
|
|
HC TEST URINE VOLUME
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
900910797
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$20.40
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.05
|
| Rate for Payer: Heritage Provider Network Senior |
$69.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$76.50
|
|
|
HC TETRACYCLINE E TEST
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912444
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$72.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.59
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$68.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$65.00
|
| Rate for Payer: Heritage Provider Network Senior |
$65.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC TETRACYCLINE E TEST
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912444
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$71.08
|
| Rate for Payer: Heritage Provider Network Senior |
$71.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
|
|
HC THAWING COMPONENT
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
900904700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$225.75 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.78
|
| Rate for Payer: Heritage Provider Network Senior |
$203.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.25
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
|
|
HC THAWING COMPONENT
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
900904700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.23 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Adventist Health Commercial |
$60.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$160.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.18
|
| Rate for Payer: Blue Shield of California Commercial |
$52.51
|
| Rate for Payer: Blue Shield of California EPN |
$42.23
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$195.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Senior |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.65
|
| Rate for Payer: EPIC Health Plan Medicare |
$217.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.32
|
| Rate for Payer: Heritage Provider Network Senior |
$186.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$143.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$274.34
|
| Rate for Payer: Multiplan Commercial |
$225.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$217.73
|
| Rate for Payer: TriValley Medical Group Senior |
$217.73
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$164.51
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$164.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
