|
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: Aetna of CA Non-Gatekeeper |
$94.02
|
| Rate for Payer: Cash Price |
$65.70
|
| 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 Foundation Hospitals 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 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: Anthem Blue Cross of CA HMO/PPO |
$66.17
|
| 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 |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$69.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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 |
$71.68 |
| Max. Negotiated Rate |
$501.00 |
| Rate for Payer: Adventist Health Commercial |
$133.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$412.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.05
|
| 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 |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$434.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$394.12
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| 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) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$318.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| 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 |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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: Aetna of CA Non-Gatekeeper |
$430.19
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$452.24
|
| Rate for Payer: Heritage Provider Network Senior |
$452.24
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
OP
|
$3,126.00
|
|
|
Service Code
|
CPT L0484
|
| Hospital Charge Code |
905350484
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$781.50 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,281.66
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,931.87
|
| 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 |
$13,770.00
|
| 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 |
$1,406.70
|
| Rate for Payer: Cash Price |
$1,406.70
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$1,563.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,563.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$625.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,013.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$1,406.70
|
| Rate for Payer: Cash Price |
$1,406.70
|
| 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 Foundation Hospitals Commercial |
$1,563.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,563.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$560.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| 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 Foundation Hospitals Commercial |
$435.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$356.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$537.66
|
| 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 |
$13,770.00
|
| 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 |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$435.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$435.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$500.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,611.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$1,125.90
|
| Rate for Payer: Cash Price |
$1,125.90
|
| 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 Foundation Hospitals Commercial |
$1,251.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,251.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$1,025.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,546.24
|
| 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 |
$13,770.00
|
| 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 |
$1,125.90
|
| Rate for Payer: Cash Price |
$1,125.90
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$1,251.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,251.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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/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
|
OP
|
$1,690.00
|
|
|
Service Code
|
CPT L0460
|
| Hospital Charge Code |
905350460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$692.90
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,044.42
|
| 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 |
$13,770.00
|
| 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 |
$760.50
|
| Rate for Payer: Cash Price |
$760.50
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$845.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$845.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$845.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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 |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$338.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,088.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| 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 |
$760.50
|
| Rate for Payer: Cash Price |
$760.50
|
| 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 Foundation Hospitals Commercial |
$845.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$845.00
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Aetna of CA Non-Gatekeeper |
$153.92
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$161.80
|
| Rate for Payer: Heritage Provider Network Senior |
$161.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: Multiplan Commercial |
$179.25
|
|
|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$47.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$147.70
|
| 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 |
$3,672.00
|
| 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 |
$107.55
|
| Rate for Payer: Cash Price |
$107.55
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$114.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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: Aetna of CA Non-Gatekeeper |
$331.66
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$348.65
|
| Rate for Payer: Heritage Provider Network Senior |
$348.65
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$71.68 |
| Max. Negotiated Rate |
$386.25 |
| Rate for Payer: Adventist Health Commercial |
$103.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$318.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.98
|
| 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 |
$231.75
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$334.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| 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) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$245.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$386.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| 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 |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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: Aetna of CA Non-Gatekeeper |
$739.96
|
| Rate for Payer: Cash Price |
$517.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$777.87
|
| Rate for Payer: Heritage Provider Network Senior |
$777.87
|
| Rate for Payer: Kaiser Foundation Hospitals 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 |
$207.97 |
| Max. Negotiated Rate |
$861.75 |
| Rate for Payer: Adventist Health Commercial |
$229.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$710.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$570.95
|
| 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 |
$517.05
|
| Rate for Payer: Cash Price |
$517.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$746.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$677.91
|
| Rate for Payer: EPIC Health Plan Medicare |
$306.88
|
| 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) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$548.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$287.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$861.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.88
|
| Rate for Payer: TriValley Medical Group Senior |
$306.88
|
| 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 |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
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: Aetna of CA Non-Gatekeeper |
$140.39
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$147.59
|
| Rate for Payer: Heritage Provider Network Senior |
$147.59
|
| Rate for Payer: Kaiser Foundation Hospitals 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
|
$49.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$153.03 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$134.72
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.20
|
| 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 Medi-Cal |
$17.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.03
|
| Rate for Payer: Blue Shield of California Commercial |
$129.72
|
| Rate for Payer: Blue Shield of California Commercial |
$129.72
|
| Rate for Payer: Blue Shield of California EPN |
$104.04
|
| Rate for Payer: Blue Shield of California EPN |
$104.04
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$141.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$31.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.62
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.13
|
| Rate for Payer: EPIC Health Plan Medicare |
$16.13
|
| Rate for Payer: Heritage Provider Network Commercial |
$134.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.33
|
| Rate for Payer: Heritage Provider Network Senior |
$134.94
|
| Rate for Payer: Heritage Provider Network Senior |
$30.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$103.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$23.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.61
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$16.13
|
| Rate for Payer: TriValley Medical Group Senior |
$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 All Other HMO/non HMO |
$17.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$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 Commercial/Exchange |
$24.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Vantage Medical Group Senior |
$16.13
|
| 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 |
$68.94 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$302.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.61
|
| 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 |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$318.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| 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) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$233.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| 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 |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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: Aetna of CA Non-Gatekeeper |
$315.56
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$331.73
|
| Rate for Payer: Heritage Provider Network Senior |
$331.73
|
| Rate for Payer: Kaiser Foundation Hospitals 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 Non-Gatekeeper |
$362.15
|
| 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 |
$386.47
|
| 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 |
$263.70
|
| Rate for Payer: Cash Price |
$263.70
|
| 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 Medicare Advantage |
$498.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$362.73
|
| Rate for Payer: Heritage Provider Network Senior |
$362.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$279.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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: Aetna of CA Non-Gatekeeper |
$377.38
|
| Rate for Payer: Cash Price |
$263.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$396.72
|
| Rate for Payer: Heritage Provider Network Senior |
$396.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.50
|
| Rate for Payer: Multiplan Commercial |
$439.50
|
|
|
HC TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.56 |
| Max. Negotiated Rate |
$648.75 |
| Rate for Payer: Adventist Health Commercial |
$173.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$557.06
|
| Rate for Payer: Cash Price |
$389.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$585.61
|
| Rate for Payer: Heritage Provider Network Senior |
$585.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.25
|
| Rate for Payer: Multiplan Commercial |
$648.75
|
|
