|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
OP
|
$5,849.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,058.67 |
| Max. Negotiated Rate |
$10,001.00 |
| Rate for Payer: Adventist Health Commercial |
$1,169.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,614.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,632.05
|
| Rate for Payer: Cash Price |
$2,632.05
|
| Rate for Payer: Cash Price |
$2,632.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,801.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,620.53
|
| Rate for Payer: Heritage Provider Network Senior |
$4,995.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,715.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,058.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,462.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,386.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,467.15
|
| Rate for Payer: TriValley Medical Group Senior |
$4,467.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10,001.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,445.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC 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 |
$40.05
|
| 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 Foundation Hospitals 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 |
$1,992.00 |
| Rate for Payer: Adventist Health Commercial |
$12.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$38.43
|
| 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 |
$1,992.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.54
|
| Rate for Payer: Blue Shield of California EPN |
$23.51
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$29.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.53
|
| Rate for Payer: Multiplan Commercial |
$46.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$37.31
|
| Rate for Payer: TriValley Medical Group Senior |
$37.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.86
|
| 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
|
$926.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$167.61 |
| Max. Negotiated Rate |
$694.50 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$596.34
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$626.90
|
| Rate for Payer: Heritage Provider Network Senior |
$626.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.50
|
| Rate for Payer: Multiplan Commercial |
$694.50
|
|
|
HC TEAR DUCT(LACRIM)SCN
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$167.61 |
| Max. Negotiated Rate |
$771.25 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$572.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$463.19
|
| Rate for Payer: Blue Shield of California Commercial |
$445.58
|
| Rate for Payer: Blue Shield of California EPN |
$358.32
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$601.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$514.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$573.19
|
| Rate for Payer: Heritage Provider Network Senior |
$573.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$441.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$591.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$694.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$565.59
|
| Rate for Payer: TriValley Medical Group Senior |
$514.17
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$463.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$463.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
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 Non-Gatekeeper |
$8.03
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
| Rate for Payer: Blue Shield of California Commercial |
$7.93
|
| Rate for Payer: Blue Shield of California EPN |
$6.34
|
| 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 Medicare Advantage |
$11.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.05
|
| Rate for Payer: Heritage Provider Network Senior |
$8.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.10
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.05
|
| 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 |
$8.37
|
| 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 Foundation Hospitals 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
|
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 |
$52.81
|
| 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 Foundation Hospitals Medi-Cal |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
|
|
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 Non-Gatekeeper |
$50.68
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$41.02
|
| Rate for Payer: Blue Shield of California Commercial |
$50.02
|
| Rate for Payer: Blue Shield of California EPN |
$40.02
|
| 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 Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.76
|
| Rate for Payer: Heritage Provider Network Senior |
$50.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$39.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$41.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC TELEMETRY ISO
|
Facility
|
IP
|
$7,887.00
|
|
| Hospital Charge Code |
902300031
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,427.55 |
| Max. Negotiated Rate |
$6,696.00 |
| Rate for Payer: Adventist Health Commercial |
$1,577.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,079.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,405.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,331.00
|
| Rate for Payer: Cash Price |
$3,549.15
|
| Rate for Payer: Cash Price |
$3,549.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,065.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,606.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,758.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,418.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,434.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,427.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,971.75
|
| Rate for Payer: Multiplan Commercial |
$5,915.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,696.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,638.00
|
|
|
HC TEMP CLOSURE/EYELIDS BY SUTURE
|
Facility
|
OP
|
$2,175.00
|
|
|
Service Code
|
CPT 67875
|
| Hospital Charge Code |
900501425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.68 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$435.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,344.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,282.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,033.12
|
| Rate for Payer: Blue Shield of California EPN |
$822.15
|
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,413.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,410.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,282.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,413.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,282.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,472.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,472.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,037.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$393.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,474.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,718.08
|
| Rate for Payer: Multiplan Commercial |
$1,631.25
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,305.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,305.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Vantage Medical Group Senior |
$1,282.15
|
|
|
HC TEMP CLOSURE/EYELIDS BY SUTURE
|
Facility
|
IP
|
$2,175.00
|
|
|
Service Code
|
CPT 67875
|
| Hospital Charge Code |
900501425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.68 |
| Max. Negotiated Rate |
$1,631.25 |
| Rate for Payer: Adventist Health Commercial |
$435.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,400.70
|
| Rate for Payer: Cash Price |
$978.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,472.47
|
| Rate for Payer: Heritage Provider Network Senior |
$1,472.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$393.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$543.75
|
| Rate for Payer: Multiplan Commercial |
$1,631.25
|
|
|
HC TEMP INSERT LEAD PCMKR DUAL
|
Facility
|
OP
|
$11,480.00
|
|
|
Service Code
|
CPT 33211
|
| Hospital Charge Code |
906811356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,077.88 |
| Max. Negotiated Rate |
$16,754.51 |
| Rate for Payer: Adventist Health Commercial |
$2,296.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,094.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,453.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,339.44
|
| Rate for Payer: Cash Price |
$5,166.00
|
| Rate for Payer: Cash Price |
$5,166.00
|
| Rate for Payer: Cash Price |
$5,166.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,462.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,643.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,771.96
|
| Rate for Payer: Heritage Provider Network Senior |
$7,771.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,475.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,077.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,240.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,870.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$8,610.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,888.00
|
| Rate for Payer: TriValley Medical Group Senior |
$6,888.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
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: Aetna of CA Non-Gatekeeper |
$7,393.12
|
| Rate for Payer: Cash Price |
$5,166.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,771.96
|
| Rate for Payer: Heritage Provider Network Senior |
$7,771.96
|
| Rate for Payer: Kaiser Foundation Hospitals 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: Aetna of CA Non-Gatekeeper |
$7,632.69
|
| Rate for Payer: Cash Price |
$5,333.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,023.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8,023.80
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$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: Aetna of CA Non-Gatekeeper |
$7,632.69
|
| Rate for Payer: Cash Price |
$5,333.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,023.80
|
| Rate for Payer: Heritage Provider Network Senior |
$8,023.80
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
450
|
| Min. Negotiated Rate |
$2,145.21 |
| Max. Negotiated Rate |
$16,754.51 |
| Rate for Payer: Adventist Health Commercial |
$2,370.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,324.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,629.70
|
| Rate for Payer: Blue Shield of California EPN |
$4,480.06
|
| Rate for Payer: Cash Price |
$5,333.40
|
| Rate for Payer: Cash Price |
$5,333.40
|
| Rate for Payer: Cash Price |
$5,333.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,703.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,643.53
|
| 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) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,653.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,145.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,240.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,963.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$8,889.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,111.20
|
| Rate for Payer: TriValley Medical Group Senior |
$7,111.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
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 |
$2,145.21 |
| Max. Negotiated Rate |
$20,222.71 |
| Rate for Payer: Adventist Health Commercial |
$2,370.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,324.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,643.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| 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 |
$5,333.40
|
| Rate for Payer: Cash Price |
$5,333.40
|
| Rate for Payer: Cash Price |
$5,333.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,703.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,965.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,707.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,643.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,556.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$10,643.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,336.39
|
| Rate for Payer: Heritage Provider Network Senior |
$13,091.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10,643.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$20,222.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,145.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,240.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,963.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14,262.33
|
| Rate for Payer: Multiplan Commercial |
$8,889.00
|
| Rate for Payer: Multiplan WC |
$16,754.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$11,707.88
|
| Rate for Payer: TriValley Medical Group Senior |
$11,707.88
|
| 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 |
$15,965.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,707.88
|
| Rate for Payer: Vantage Medical Group Senior |
$10,643.53
|
|
|
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 |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,208.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$928.62
|
| Rate for Payer: Blue Shield of California EPN |
$738.99
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,270.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,270.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$850.08
|
| 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) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$932.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,139.11
|
| Rate for Payer: Multiplan Commercial |
$1,466.25
|
| Rate for Payer: Multiplan WC |
$1,324.78
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,173.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,173.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
HC TEMP TRANSCUTANEOUS PACING
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
906811141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$353.86 |
| Max. Negotiated Rate |
$8,962.13 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,208.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,153.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$850.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,210.14
|
| Rate for Payer: Heritage Provider Network Senior |
$1,045.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,615.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,139.11
|
| Rate for Payer: Multiplan Commercial |
$1,466.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$935.09
|
| Rate for Payer: TriValley Medical Group Senior |
$850.08
|
| 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 |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
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: Aetna of CA Non-Gatekeeper |
$1,259.02
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$1,259.02
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,323.54
|
| Rate for Payer: Heritage Provider Network Senior |
$1,323.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.75
|
| Rate for Payer: Multiplan Commercial |
$1,466.25
|
|
|
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: Aetna of CA Non-Gatekeeper |
$3,284.40
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,452.70
|
| Rate for Payer: Heritage Provider Network Senior |
$3,452.70
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$923.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,151.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,422.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,927.80
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cash Price |
$2,295.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,315.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,068.15
|
| 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) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,432.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$923.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,275.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,060.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,060.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
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: Aetna of CA Non-Gatekeeper |
$205.44
|
| Rate for Payer: Cash Price |
$143.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$215.96
|
| Rate for Payer: Heritage Provider Network Senior |
$215.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.75
|
| Rate for Payer: Multiplan Commercial |
$239.25
|
|
