|
HC CATHETERIZATION-SPECIMEN ONLY
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
907201169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.48
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$115.77
|
| Rate for Payer: Heritage Provider Network Senior |
$115.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
|
|
HC CATHETERIZATION-SPECIMEN ONLY
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
907201169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$1,335.00 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$117.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.57
|
| Rate for Payer: Blue Shield of California Commercial |
$16.77
|
| Rate for Payer: Blue Shield of California EPN |
$13.11
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$111.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.43
|
| Rate for Payer: Dignity Health Senior |
$8.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.15
|
| Rate for Payer: EPIC Health Plan Medicare |
$8.57
|
| Rate for Payer: Heritage Provider Network Commercial |
$105.85
|
| Rate for Payer: Heritage Provider Network Senior |
$105.85
|
| Rate for Payer: Humana Medicare |
$8.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$8.57
|
| Rate for Payer: TriValley Medical Group Senior |
$8.57
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.43
|
| Rate for Payer: Vantage Medical Group Senior |
$8.57
|
|
|
HC CATHETER MEDTRONIC ASPIRATION
|
Facility
|
OP
|
$2,710.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.60 |
| Max. Negotiated Rate |
$2,303.92 |
| Rate for Payer: Adventist Health Commercial |
$542.10
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,266.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,862.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,303.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,490.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,032.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,683.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,591.06
|
| Rate for Payer: Cash Price |
$1,219.73
|
| Rate for Payer: Cash Price |
$1,219.73
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,761.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,303.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,303.92
|
| Rate for Payer: Dignity Health Senior |
$2,303.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,761.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,677.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,677.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,306.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.62
|
| Rate for Payer: Multiplan Commercial |
$2,032.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,303.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2,303.92
|
|
|
HC CATHETER MEDTRONIC ASPIRATION
|
Facility
|
IP
|
$2,710.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.60 |
| Max. Negotiated Rate |
$2,032.88 |
| Rate for Payer: Adventist Health Commercial |
$542.10
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,862.11
|
| Rate for Payer: Cash Price |
$1,219.73
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,835.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,835.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$490.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$677.62
|
| Rate for Payer: Multiplan Commercial |
$2,032.88
|
|
|
HC CATHETER, MULTI MARKER
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.27 |
| Max. Negotiated Rate |
$1,231.65 |
| Rate for Payer: Adventist Health Commercial |
$289.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,062.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$995.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,231.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$796.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,086.75
|
| Rate for Payer: Blue Shield of California Commercial |
$899.83
|
| Rate for Payer: Blue Shield of California EPN |
$850.56
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$941.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,231.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,231.65
|
| Rate for Payer: Dignity Health Senior |
$1,231.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$941.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$896.93
|
| Rate for Payer: Heritage Provider Network Senior |
$896.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$698.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.25
|
| Rate for Payer: Multiplan Commercial |
$1,086.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,231.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,231.65
|
|
|
HC CATHETER, MULTI MARKER
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.27 |
| Max. Negotiated Rate |
$1,086.75 |
| Rate for Payer: Adventist Health Commercial |
$289.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$995.46
|
| Rate for Payer: Cash Price |
$652.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$980.97
|
| Rate for Payer: Heritage Provider Network Senior |
$980.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$362.25
|
| Rate for Payer: Multiplan Commercial |
$1,086.75
|
|
|
HC CATHETER PIONEER
|
Facility
|
IP
|
$7,987.50
|
|
|
Service Code
|
CPT C1753
|
| Hospital Charge Code |
909020110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,445.74 |
| Max. Negotiated Rate |
$5,990.62 |
| Rate for Payer: Adventist Health Commercial |
$1,597.50
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,487.41
|
| Rate for Payer: Cash Price |
$3,594.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,407.54
|
| Rate for Payer: Heritage Provider Network Senior |
$5,407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,445.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,996.88
|
| Rate for Payer: Multiplan Commercial |
$5,990.62
|
|
|
HC CATHETER PIONEER
|
Facility
|
OP
|
$7,987.50
|
|
|
Service Code
|
CPT C1753
|
| Hospital Charge Code |
909020110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,445.74 |
| Max. Negotiated Rate |
$6,789.38 |
| Rate for Payer: Adventist Health Commercial |
$1,597.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,764.32
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,487.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,789.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,393.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,990.62
|
| Rate for Payer: Blue Shield of California Commercial |
$4,960.24
|
| Rate for Payer: Blue Shield of California EPN |
$4,688.66
|
| Rate for Payer: Cash Price |
$3,594.38
|
| Rate for Payer: Cash Price |
$3,594.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,191.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,789.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,789.38
|
| Rate for Payer: Dignity Health Senior |
$6,789.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,191.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,944.26
|
| Rate for Payer: Heritage Provider Network Senior |
$4,944.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,849.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,445.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,996.88
|
| Rate for Payer: Multiplan Commercial |
$5,990.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,789.38
|
| Rate for Payer: Vantage Medical Group Senior |
$6,789.38
|
|
|
HC CATH GUIDE CELLO
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909031887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,421.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,289.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Senior |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,496.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,805.70
|
| Rate for Payer: Heritage Provider Network Senior |
$1,805.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC CATH GUIDE CELLO
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909031887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,872.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,679.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,794.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,106.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,640.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,640.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,950.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,421.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,302.99
|
|
|
HC CATH GUIDT SWIFT NINJA
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909001769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,632.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,300.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,300.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,777.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.74
|
|
|
HC CATH GUIDT SWIFT NINJA
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909001769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,027.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,861.62
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Senior |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,777.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC CATH HEMODIALYSIS LONG TERM
|
Facility
|
OP
|
$2,148.20
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.64 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$429.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,031.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,475.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,825.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,611.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,334.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,260.99
|
| Rate for Payer: Cash Price |
$966.69
|
| Rate for Payer: Cash Price |
$966.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$988.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,825.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,825.97
|
| Rate for Payer: Dignity Health Senior |
$1,825.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,374.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$994.62
|
| Rate for Payer: Heritage Provider Network Senior |
$994.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,074.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,074.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.05
|
| Rate for Payer: Multiplan Commercial |
$1,611.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$783.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$717.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,825.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,825.97
|
|
|
HC CATH HEMODIALYSIS LONG TERM
|
Facility
|
IP
|
$2,148.20
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.64 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$429.64
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,031.14
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,475.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$966.69
|
| Rate for Payer: Cash Price |
$966.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$988.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,160.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,454.33
|
| Rate for Payer: Heritage Provider Network Senior |
$1,454.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,074.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,074.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.05
|
| Rate for Payer: Multiplan Commercial |
$1,611.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$783.23
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$717.71
|
|
|
HC CATH HEMODIALYSIS SHORT-TERM
|
Facility
|
OP
|
$376.24
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$75.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$258.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$319.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$233.65
|
| Rate for Payer: Blue Shield of California EPN |
$220.85
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$319.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$319.80
|
| Rate for Payer: Dignity Health Senior |
$319.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$174.20
|
| Rate for Payer: Heritage Provider Network Senior |
$174.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$188.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.06
|
| Rate for Payer: Multiplan Commercial |
$282.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$319.80
|
| Rate for Payer: Vantage Medical Group Senior |
$319.80
|
|
|
HC CATH HEMODIALYSIS SHORT-TERM
|
Facility
|
IP
|
$376.24
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
909081449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$75.25
|
| Rate for Payer: Aetna of CA Gatekeeper |
$180.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$258.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Cash Price |
$169.31
|
| Rate for Payer: Cigna of CA HMO/PPO |
$173.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$254.71
|
| Rate for Payer: Heritage Provider Network Senior |
$254.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$188.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.06
|
| Rate for Payer: Multiplan Commercial |
$282.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$137.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$125.70
|
|
|
HC CATH INDIGO THROM
|
Facility
|
IP
|
$4,875.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,632.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,300.38
|
| Rate for Payer: Heritage Provider Network Senior |
$3,300.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,777.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.74
|
|
|
HC CATH INDIGO THROM
|
Facility
|
OP
|
$4,875.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,340.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,349.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,027.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,861.62
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,242.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: Dignity Health Senior |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,257.12
|
| Rate for Payer: Heritage Provider Network Senior |
$2,257.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,437.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,218.75
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,777.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,628.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC CATH INTRVASC U/S
|
Facility
|
OP
|
$5,250.00
|
|
|
Service Code
|
CPT C1753
|
| Hospital Charge Code |
909000267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,050.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,520.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,606.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,462.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,937.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,260.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,081.75
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,415.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,462.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,462.50
|
| Rate for Payer: Dignity Health Senior |
$4,462.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,360.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,430.75
|
| Rate for Payer: Heritage Provider Network Senior |
$2,430.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,625.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,625.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,625.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,312.50
|
| Rate for Payer: Multiplan Commercial |
$3,937.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,914.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,754.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,462.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,462.50
|
|
|
HC CATH INTRVASC U/S
|
Facility
|
IP
|
$5,250.00
|
|
|
Service Code
|
CPT C1753
|
| Hospital Charge Code |
909000267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,050.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,520.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,606.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: Cash Price |
$2,362.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,415.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,835.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,554.25
|
| Rate for Payer: Heritage Provider Network Senior |
$3,554.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,625.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,625.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,625.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,312.50
|
| Rate for Payer: Multiplan Commercial |
$3,937.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,914.15
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,754.02
|
|
|
HC CATH PENUMBRA 3D STNT RTRVR
|
Facility
|
IP
|
$17,156.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909011757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,431.20 |
| Max. Negotiated Rate |
$12,867.00 |
| Rate for Payer: Adventist Health Commercial |
$3,431.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8,234.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,786.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$7,720.20
|
| Rate for Payer: Cash Price |
$7,720.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,891.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,264.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,614.61
|
| Rate for Payer: Heritage Provider Network Senior |
$11,614.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,578.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,578.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,578.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,289.00
|
| Rate for Payer: Multiplan Commercial |
$12,867.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,255.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,731.82
|
|
|
HC CATH PENUMBRA 3D STNT RTRVR
|
Facility
|
OP
|
$17,156.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909011757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,431.20 |
| Max. Negotiated Rate |
$14,582.60 |
| Rate for Payer: Adventist Health Commercial |
$3,431.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$8,234.88
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,786.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,582.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,435.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,867.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,653.88
|
| Rate for Payer: Blue Shield of California EPN |
$10,070.57
|
| Rate for Payer: Cash Price |
$7,720.20
|
| Rate for Payer: Cash Price |
$7,720.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,891.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,582.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,582.60
|
| Rate for Payer: Dignity Health Senior |
$14,582.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,979.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,943.23
|
| Rate for Payer: Heritage Provider Network Senior |
$7,943.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,578.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,578.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,578.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,289.00
|
| Rate for Payer: Multiplan Commercial |
$12,867.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,255.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,731.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,582.60
|
| Rate for Payer: Vantage Medical Group Senior |
$14,582.60
|
|
|
HC CATH PENUMBRA SELECT
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$278.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$266.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$392.66
|
| Rate for Payer: Heritage Provider Network Senior |
$392.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$211.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$193.78
|
|
|
HC CATH PENUMBRA SELECT
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$278.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$360.18
|
| Rate for Payer: Blue Shield of California EPN |
$340.46
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$266.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Senior |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.54
|
| Rate for Payer: Heritage Provider Network Senior |
$268.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$211.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$193.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC CATH PICC PWR 4.5FR 55CM SL
|
Facility
|
IP
|
$1,405.85
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.17 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$281.17
|
| Rate for Payer: Aetna of CA Gatekeeper |
$674.81
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$965.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$632.63
|
| Rate for Payer: Cash Price |
$632.63
|
| Rate for Payer: Cigna of CA HMO/PPO |
$646.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$759.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$951.76
|
| Rate for Payer: Heritage Provider Network Senior |
$951.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$702.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$702.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.46
|
| Rate for Payer: Multiplan Commercial |
$1,054.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$512.57
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$469.69
|
|
