|
HC TISSUE MARKER 8 GA
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909001129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$81.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$195.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$163.61
|
| Rate for Payer: Blue Shield of California EPN |
$163.61
|
| Rate for Payer: Cash Price |
$223.85
|
| Rate for Payer: Cash Price |
$223.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$187.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.78
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.44
|
| Rate for Payer: Heritage Provider Network Senior |
$188.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$203.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.75
|
| Rate for Payer: Multiplan Commercial |
$305.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$147.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$134.76
|
|
|
HC TL-201 THAL CL PER MCI THALLIU
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT A9505
|
| Hospital Charge Code |
909301524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$124.10 |
| Rate for Payer: Adventist Health Commercial |
$29.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$124.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.50
|
| Rate for Payer: Blue Shield of California Commercial |
$89.06
|
| Rate for Payer: Blue Shield of California EPN |
$71.25
|
| Rate for Payer: Cash Price |
$80.30
|
| Rate for Payer: Cash Price |
$80.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$124.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.10
|
| Rate for Payer: Dignity Health Senior |
$124.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.60
|
| Rate for Payer: Heritage Provider Network Senior |
$67.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$69.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.20
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$58.40
|
| Rate for Payer: TriValley Medical Group Senior |
$58.40
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$52.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$124.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.10
|
| Rate for Payer: Vantage Medical Group Senior |
$124.10
|
|
|
HC TL-201 THAL CL PER MCI THALLIU
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT A9505
|
| Hospital Charge Code |
909301524
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.43 |
| Max. Negotiated Rate |
$109.50 |
| Rate for Payer: Adventist Health Commercial |
$29.20
|
| Rate for Payer: Cash Price |
$80.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$67.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.60
|
| Rate for Payer: Heritage Provider Network Senior |
$67.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.50
|
| Rate for Payer: Multiplan Commercial |
$109.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$52.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$48.34
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.37 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$357.05
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$458.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.05
|
| Rate for Payer: Blue Shield of California Commercial |
$141.12
|
| Rate for Payer: Blue Shield of California EPN |
$113.48
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$413.49
|
| Rate for Payer: Heritage Provider Network Senior |
$413.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$44.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$318.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.91 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Cash Price |
$367.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$452.24
|
| Rate for Payer: Heritage Provider Network Senior |
$452.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
|
|
HC TLSO TRIPLANAR CNTRL 2 PIECE
|
Facility
|
IP
|
$3,126.00
|
|
|
Service Code
|
CPT L0484
|
| Hospital Charge Code |
905350484
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$625.20 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$625.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,500.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,256.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,256.65
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,437.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,688.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,447.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,447.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,563.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,563.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,563.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.50
|
| Rate for Payer: Multiplan Commercial |
$2,344.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,129.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,035.02
|
|
|
HC TLSO TRIPLANAR CNTRL 2 PIECE
|
Facility
|
OP
|
$3,126.00
|
|
|
Service Code
|
CPT L0484
|
| Hospital Charge Code |
905350484
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$781.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,281.66
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,500.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,147.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,657.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,719.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,344.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,256.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,256.65
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cash Price |
$1,719.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,437.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,657.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,657.10
|
| Rate for Payer: Dignity Health Senior |
$2,657.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,447.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,447.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,025.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,563.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,563.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,563.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,188.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,188.20
|
| Rate for Payer: Multiplan Commercial |
$2,344.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,129.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,035.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,657.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,657.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,657.10
|
|
|
HC TLSO TRIPLANAR CNTRL HYPEREXT
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT L0472
|
| Hospital Charge Code |
905350472
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$356.70
|
| Rate for Payer: Aetna of CA Gatekeeper |
$417.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$597.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$652.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$349.74
|
| Rate for Payer: Blue Shield of California EPN |
$349.74
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$400.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$739.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$739.50
|
| Rate for Payer: Dignity Health Senior |
$739.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$556.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$402.81
|
| Rate for Payer: Heritage Provider Network Senior |
$402.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$525.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$435.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$435.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$609.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$609.00
|
| Rate for Payer: Multiplan Commercial |
$652.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$314.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$288.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$739.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$739.50
|
| Rate for Payer: Vantage Medical Group Senior |
$739.50
|
|
|
HC TLSO TRIPLANAR CNTRL HYPEREXT
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT L0472
|
| Hospital Charge Code |
905350472
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$417.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$349.74
|
| Rate for Payer: Blue Shield of California EPN |
$349.74
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$400.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$402.81
|
| Rate for Payer: Heritage Provider Network Senior |
$402.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$435.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$435.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.50
|
| Rate for Payer: Multiplan Commercial |
$652.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$314.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$288.06
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 4 SHE
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT L0464
|
| Hospital Charge Code |
905350464
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$500.40 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,200.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,005.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,005.80
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,150.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,351.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,158.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,158.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,251.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,251.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.50
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$903.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$828.41
|
|
|
HC TLSO TRIPLANAR CNTRL SEG 4 SHE
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT L0464
|
| Hospital Charge Code |
905350464
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$625.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,025.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,200.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,718.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,376.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,876.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,005.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,005.80
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cash Price |
$1,376.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,150.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,126.70
|
| Rate for Payer: Dignity Health Senior |
$2,126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,601.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,158.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,158.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,513.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,251.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,251.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,251.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$625.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,751.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,751.40
|
| Rate for Payer: Multiplan Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$903.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$828.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,126.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,126.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,126.70
|
|
|
HC TLSO TRIPLANAR CNTRL SEG STERN
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
905350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$338.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$811.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$679.38
|
| Rate for Payer: Blue Shield of California EPN |
$679.38
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$777.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$912.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$782.47
|
| Rate for Payer: Heritage Provider Network Senior |
$782.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$845.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$845.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.50
|
| Rate for Payer: Multiplan Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$610.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$559.56
|
|
|
HC TLSO TRIPLANAR CNTRL SEG STERN
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
905350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$692.90
|
| Rate for Payer: Aetna of CA Gatekeeper |
$811.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,161.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$929.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,267.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$679.38
|
| Rate for Payer: Blue Shield of California EPN |
$679.38
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$777.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.50
|
| Rate for Payer: Dignity Health Senior |
$1,436.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,081.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$782.47
|
| Rate for Payer: Heritage Provider Network Senior |
$782.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,022.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$845.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$845.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$845.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,183.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,183.00
|
| Rate for Payer: Multiplan Commercial |
$1,267.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$610.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$559.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,436.50
|
|
|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$164.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$203.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.25
|
| 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 |
$131.45
|
| Rate for Payer: Cash Price |
$131.45
|
| Rate for Payer: Cash Price |
$131.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$155.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$203.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.15
|
| Rate for Payer: Dignity Health Senior |
$203.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.94
|
| Rate for Payer: Heritage Provider Network Senior |
$147.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$221.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$114.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$167.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$167.30
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
| 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 |
$203.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.15
|
| Rate for Payer: Vantage Medical Group Senior |
$203.15
|
|
|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$179.25 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Cash Price |
$131.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.80
|
| Rate for Payer: Heritage Provider Network Senior |
$161.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
|
|
HC TMJ OPEN CLOSE UNILATERAL
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
909001164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.22 |
| Max. Negotiated Rate |
$386.25 |
| Rate for Payer: Adventist Health Commercial |
$103.00
|
| Rate for Payer: Cash Price |
$283.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$348.65
|
| Rate for Payer: Heritage Provider Network Senior |
$348.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.75
|
| Rate for Payer: Multiplan Commercial |
$386.25
|
|
|
HC TMJ OPEN CLOSE UNILATERAL
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
909001164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.61 |
| Max. Negotiated Rate |
$386.25 |
| Rate for Payer: Adventist Health Commercial |
$103.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$275.27
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$353.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.83
|
| Rate for Payer: Blue Shield of California Commercial |
$101.86
|
| Rate for Payer: Blue Shield of California EPN |
$81.91
|
| Rate for Payer: Cash Price |
$283.25
|
| Rate for Payer: Cash Price |
$283.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$334.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$318.79
|
| Rate for Payer: Heritage Provider Network Senior |
$318.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$245.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$386.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC TM JT ARTHROGRAM
|
Facility
|
IP
|
$1,149.00
|
|
|
Service Code
|
CPT 70332
|
| Hospital Charge Code |
909001166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.97 |
| Max. Negotiated Rate |
$861.75 |
| Rate for Payer: Adventist Health Commercial |
$229.80
|
| Rate for Payer: Cash Price |
$631.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$777.87
|
| Rate for Payer: Heritage Provider Network Senior |
$777.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.25
|
| Rate for Payer: Multiplan Commercial |
$861.75
|
|
|
HC TM JT ARTHROGRAM
|
Facility
|
OP
|
$1,149.00
|
|
|
Service Code
|
CPT 70332
|
| Hospital Charge Code |
909001166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$861.75 |
| Rate for Payer: Adventist Health Commercial |
$229.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$614.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$789.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$548.99
|
| Rate for Payer: Blue Shield of California Commercial |
$441.55
|
| Rate for Payer: Blue Shield of California EPN |
$355.08
|
| Rate for Payer: Cash Price |
$631.95
|
| Rate for Payer: Cash Price |
$631.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$746.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Senior |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$746.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$307.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$711.23
|
| Rate for Payer: Heritage Provider Network Senior |
$711.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$548.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$353.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$386.98
|
| Rate for Payer: Multiplan Commercial |
$861.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$307.13
|
| Rate for Payer: TriValley Medical Group Senior |
$307.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC TOBRAMYCIN
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
|
|
HC TOBRAMYCIN
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$116.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$149.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.14
|
| Rate for Payer: Blue Shield of California Commercial |
$129.72
|
| Rate for Payer: Blue Shield of California EPN |
$104.04
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.74
|
| Rate for Payer: Dignity Health Senior |
$16.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.32
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.13
|
| Rate for Payer: TriValley Medical Group Senior |
$16.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$17.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Vantage Medical Group Senior |
$16.13
|
|
|
HC TOES
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$261.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$336.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.20
|
| Rate for Payer: Blue Shield of California Commercial |
$85.73
|
| Rate for Payer: Blue Shield of California EPN |
$68.94
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$318.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.31
|
| Rate for Payer: Heritage Provider Network Senior |
$303.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$233.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC TOES
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$331.73
|
| Rate for Payer: Heritage Provider Network Senior |
$331.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.50
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
|
|
HC TOMOGRAPHY COMPLEX MOTION BODY SEC
|
Facility
|
OP
|
$586.00
|
|
|
Service Code
|
CPT 76101
|
| Hospital Charge Code |
909001156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.07 |
| Max. Negotiated Rate |
$498.10 |
| Rate for Payer: Adventist Health Commercial |
$117.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$313.22
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$402.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$498.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$322.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$439.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.61
|
| Rate for Payer: Blue Shield of California Commercial |
$357.46
|
| Rate for Payer: Blue Shield of California EPN |
$285.97
|
| Rate for Payer: Cash Price |
$322.30
|
| Rate for Payer: Cash Price |
$322.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$380.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$498.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$498.10
|
| Rate for Payer: Dignity Health Senior |
$498.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.73
|
| Rate for Payer: Heritage Provider Network Senior |
$362.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$279.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.20
|
| Rate for Payer: Multiplan Commercial |
$439.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$293.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$293.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$498.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$498.10
|
| Rate for Payer: Vantage Medical Group Senior |
$498.10
|
|
|
HC TOMOGRAPHY COMPLEX MOTION BODY SEC
|
Facility
|
IP
|
$586.00
|
|
|
Service Code
|
CPT 76101
|
| Hospital Charge Code |
909001156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.07 |
| Max. Negotiated Rate |
$439.50 |
| Rate for Payer: Adventist Health Commercial |
$117.20
|
| Rate for Payer: Cash Price |
$322.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$396.72
|
| Rate for Payer: Heritage Provider Network Senior |
$396.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.50
|
| Rate for Payer: Multiplan Commercial |
$439.50
|
|
