|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
906820179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$533.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$582.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$504.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$659.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$659.60
|
| Rate for Payer: Dignity Health Senior |
$659.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.34
|
| Rate for Payer: Heritage Provider Network Senior |
$480.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$374.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$659.60
|
| Rate for Payer: Vantage Medical Group Senior |
$659.60
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
906820179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.46 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$533.11
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$525.35
|
| Rate for Payer: Heritage Provider Network Senior |
$525.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
IP
|
$3,145.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
909081319
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.24 |
| Max. Negotiated Rate |
$2,358.75 |
| Rate for Payer: Adventist Health Commercial |
$629.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,160.62
|
| Rate for Payer: Cash Price |
$1,415.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,129.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,129.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.25
|
| Rate for Payer: Multiplan Commercial |
$2,358.75
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
IP
|
$2,030.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
906820176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.43 |
| Max. Negotiated Rate |
$1,522.50 |
| Rate for Payer: Adventist Health Commercial |
$406.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,394.61
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,374.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,374.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.50
|
| Rate for Payer: Multiplan Commercial |
$1,522.50
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
OP
|
$2,030.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
906820176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$406.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,394.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,725.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,116.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,522.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,319.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,725.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,725.50
|
| Rate for Payer: Dignity Health Senior |
$1,725.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,256.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,256.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$281.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$978.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.50
|
| Rate for Payer: Multiplan Commercial |
$1,522.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,725.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,725.50
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
|
OP
|
$3,145.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
909081319
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$629.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,160.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,673.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,729.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,358.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,415.25
|
| Rate for Payer: Cash Price |
$1,415.25
|
| Rate for Payer: Cash Price |
$1,415.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,044.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,673.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,673.25
|
| Rate for Payer: Dignity Health Senior |
$2,673.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,946.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,946.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$281.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,515.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.25
|
| Rate for Payer: Multiplan Commercial |
$2,358.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,673.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,673.25
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
IP
|
$2,725.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
909081320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$493.22 |
| Max. Negotiated Rate |
$2,043.75 |
| Rate for Payer: Adventist Health Commercial |
$545.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,872.08
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,844.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,844.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.25
|
| Rate for Payer: Multiplan Commercial |
$2,043.75
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
OP
|
$2,725.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
909081320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$545.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,872.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,316.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,498.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,043.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,771.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,316.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,316.25
|
| Rate for Payer: Dignity Health Senior |
$2,316.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,686.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,686.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,313.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.25
|
| Rate for Payer: Multiplan Commercial |
$2,043.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,316.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,316.25
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
906820177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$706.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$874.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$771.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$668.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$874.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.65
|
| Rate for Payer: Dignity Health Senior |
$874.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$636.95
|
| Rate for Payer: Heritage Provider Network Senior |
$636.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$495.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.65
|
| Rate for Payer: Vantage Medical Group Senior |
$874.65
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
906820177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$771.75 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$706.92
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$696.63
|
| Rate for Payer: Heritage Provider Network Senior |
$696.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
IP
|
$1,106.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
906820178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.19 |
| Max. Negotiated Rate |
$829.50 |
| Rate for Payer: Adventist Health Commercial |
$221.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.82
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$748.76
|
| Rate for Payer: Heritage Provider Network Senior |
$748.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.50
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
OP
|
$2,904.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
909081321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$410.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$580.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,995.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,468.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,597.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,178.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,887.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,468.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,468.40
|
| Rate for Payer: Dignity Health Senior |
$2,468.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,797.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,797.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$410.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,399.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$726.00
|
| Rate for Payer: Multiplan Commercial |
$2,178.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,468.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.40
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
906820178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$221.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$940.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$829.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$718.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$940.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$940.10
|
| Rate for Payer: Dignity Health Senior |
$940.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$684.61
|
| Rate for Payer: Heritage Provider Network Senior |
$684.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$410.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$533.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.50
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$940.10
|
| Rate for Payer: Vantage Medical Group Senior |
$940.10
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
IP
|
$2,904.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
909081321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Adventist Health Commercial |
$580.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,995.05
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,966.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,966.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$726.00
|
| Rate for Payer: Multiplan Commercial |
$2,178.00
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$805.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.90
|
| Rate for Payer: Dignity Health Senior |
$912.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$517.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$389.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$358.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.90
|
| Rate for Payer: Vantage Medical Group Senior |
$912.90
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
906820099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$195.66 |
| Max. Negotiated Rate |
$810.75 |
| Rate for Payer: Adventist Health Commercial |
$216.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$742.65
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$731.84
|
| Rate for Payer: Heritage Provider Network Senior |
$731.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.25
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
906820099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$216.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$742.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$918.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$594.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$810.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$702.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$918.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$918.85
|
| Rate for Payer: Dignity Health Senior |
$918.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$669.14
|
| Rate for Payer: Heritage Provider Network Senior |
$669.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$521.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.25
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$918.85
|
| Rate for Payer: Vantage Medical Group Senior |
$918.85
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$727.10
|
| Rate for Payer: Heritage Provider Network Senior |
$727.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$214.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$737.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$912.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$805.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cash Price |
$483.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$698.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.90
|
| Rate for Payer: Dignity Health Senior |
$912.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$664.81
|
| Rate for Payer: Heritage Provider Network Senior |
$664.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$517.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$194.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$805.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.90
|
| Rate for Payer: Vantage Medical Group Senior |
$912.90
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
IP
|
$7,509.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
909081625
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,359.13 |
| Max. Negotiated Rate |
$5,631.75 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,083.59
|
| Rate for Payer: Heritage Provider Network Senior |
$5,083.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
IP
|
$11,845.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
906820193
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,143.94 |
| Max. Negotiated Rate |
$8,883.75 |
| Rate for Payer: Adventist Health Commercial |
$2,369.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,137.52
|
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,019.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8,019.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,143.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,961.25
|
| Rate for Payer: Multiplan Commercial |
$8,883.75
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
OP
|
$11,845.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
906820193
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$201.79 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$2,369.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$388.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,137.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,699.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,699.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,332.06
|
| Rate for Payer: Heritage Provider Network Senior |
$7,332.06
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,143.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,961.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$8,883.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
OP
|
$7,509.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
909081625
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$201.79 |
| Max. Negotiated Rate |
$13,045.53 |
| Rate for Payer: Adventist Health Commercial |
$1,501.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$388.85
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,158.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,017.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,569.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,461.45
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cash Price |
$3,379.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,880.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,880.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,648.07
|
| Rate for Payer: Heritage Provider Network Senior |
$4,648.07
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13,045.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,877.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$5,631.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$6,866.07
|
| Rate for Payer: TriValley Medical Group Senior |
$6,866.07
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Adventist Health Commercial |
$123.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$423.19
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$417.03
|
| Rate for Payer: Heritage Provider Network Senior |
$417.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$462.00
|
|
