|
HC CATH PICC PWR 4.5FR 55CM SL
|
Facility
|
OP
|
$1,405.85
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.17 |
| Max. Negotiated Rate |
$12,139.00 |
| 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: Alpha Care Medical Group Commercial/Exchange |
$1,194.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,054.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$873.03
|
| Rate for Payer: Blue Shield of California EPN |
$825.23
|
| 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: Dignity Health Commercial/Exchange |
$1,194.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,194.97
|
| Rate for Payer: Dignity Health Senior |
$1,194.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$899.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$650.91
|
| Rate for Payer: Heritage Provider Network Senior |
$650.91
|
| 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
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,194.97
|
| Rate for Payer: Vantage Medical Group Senior |
$1,194.97
|
|
|
HC CATH POWERLINE TUNNELED
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909000028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$706.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,011.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$914.11
|
| Rate for Payer: Blue Shield of California EPN |
$864.06
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$677.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.20
|
| Rate for Payer: Dignity Health Senior |
$1,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$942.08
|
| Rate for Payer: Heritage Provider Network Commercial |
$681.54
|
| Rate for Payer: Heritage Provider Network Senior |
$681.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$736.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$736.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$736.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.00
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$536.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$491.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,251.20
|
|
|
HC CATH POWERLINE TUNNELED
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909000028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$706.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,011.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$677.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$996.54
|
| Rate for Payer: Heritage Provider Network Senior |
$996.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$736.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$736.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$736.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.00
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$536.69
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$491.80
|
|
|
HC CATH RESCUE
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
900800869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$310.01
|
| 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: 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: Cigna of CA HMO/PPO |
$377.00
|
| 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 |
$377.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$359.02
|
| Rate for Payer: Heritage Provider Network Senior |
$359.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$279.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC CATH RESCUE
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
900800869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$398.46
|
| Rate for Payer: Cash Price |
$261.00
|
| 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 Medi-Cal |
$104.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
|
|
HC CATH RESCUE SUCTION OMNEOTECH
|
Facility
|
OP
|
$374.10
|
|
| Hospital Charge Code |
900800713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.71 |
| Max. Negotiated Rate |
$317.98 |
| Rate for Payer: Adventist Health Commercial |
$74.82
|
| Rate for Payer: Aetna of CA Gatekeeper |
$199.96
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$280.58
|
| Rate for Payer: Blue Shield of California Commercial |
$232.32
|
| Rate for Payer: Blue Shield of California EPN |
$219.60
|
| Rate for Payer: Cash Price |
$168.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$243.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.98
|
| Rate for Payer: Dignity Health Senior |
$317.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$231.57
|
| Rate for Payer: Heritage Provider Network Senior |
$231.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$180.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.52
|
| Rate for Payer: Multiplan Commercial |
$280.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.98
|
| Rate for Payer: Vantage Medical Group Senior |
$317.98
|
|
|
HC CATH RESCUE SUCTION OMNEOTECH
|
Facility
|
IP
|
$374.10
|
|
| Hospital Charge Code |
900800713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.71 |
| Max. Negotiated Rate |
$280.58 |
| Rate for Payer: Adventist Health Commercial |
$74.82
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$257.01
|
| Rate for Payer: Cash Price |
$168.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$253.27
|
| Rate for Payer: Heritage Provider Network Senior |
$253.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.52
|
| Rate for Payer: Multiplan Commercial |
$280.58
|
|
|
HC CATH SUREFIRE MICROCATH
|
Facility
|
OP
|
$9,574.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909001887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,914.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,595.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,577.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,137.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,265.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,180.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,945.45
|
| Rate for Payer: Blue Shield of California EPN |
$5,619.94
|
| Rate for Payer: Cash Price |
$4,308.30
|
| Rate for Payer: Cash Price |
$4,308.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,404.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,137.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,137.90
|
| Rate for Payer: Dignity Health Senior |
$8,137.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,127.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,432.76
|
| Rate for Payer: Heritage Provider Network Senior |
$4,432.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,787.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,787.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,787.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.50
|
| Rate for Payer: Multiplan Commercial |
$7,180.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,490.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,198.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,137.90
|
| Rate for Payer: Vantage Medical Group Senior |
$8,137.90
|
|
|
HC CATH SUREFIRE MICROCATH
|
Facility
|
IP
|
$9,574.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909001887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,914.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$1,914.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,595.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,577.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$4,308.30
|
| Rate for Payer: Cash Price |
$4,308.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,404.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,169.96
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,481.60
|
| Rate for Payer: Heritage Provider Network Senior |
$6,481.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,787.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,787.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,787.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.50
|
| Rate for Payer: Multiplan Commercial |
$7,180.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,490.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,198.67
|
|
|
HC CATH THROMBEC BALLOON
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$357.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$462.02
|
| Rate for Payer: Blue Shield of California EPN |
$436.73
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$342.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.40
|
| Rate for Payer: Dignity Health Senior |
$632.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$476.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$344.47
|
| Rate for Payer: Heritage Provider Network Senior |
$344.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$372.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$558.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$271.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$248.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.40
|
| Rate for Payer: Vantage Medical Group Senior |
$632.40
|
|
|
HC CATH THROMBEC BALLOON
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$357.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$511.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$342.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Heritage Provider Network Senior |
$503.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$372.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$558.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$271.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$248.57
|
|
|
HC CATH THROMBECTOMY PENUMBRA
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020025
|
|
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 THROMBECTOMY PENUMBRA
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020025
|
|
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 WINGMAN CROSSING
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.46 |
| Max. Negotiated Rate |
$9,389.21 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$9,389.21
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,666.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Blue Shield of California Commercial |
$2,410.10
|
| Rate for Payer: Blue Shield of California EPN |
$2,278.15
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,522.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Senior |
$3,298.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,522.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,402.34
|
| Rate for Payer: Heritage Provider Network Senior |
$2,402.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,870.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC CATH WINGMAN CROSSING
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.46 |
| Max. Negotiated Rate |
$2,910.75 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,666.25
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,627.44
|
| Rate for Payer: Heritage Provider Network Senior |
$2,627.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$970.25
|
| Rate for Payer: Multiplan Commercial |
$2,910.75
|
|
|
HC CAVERNOSGRAPHY INJECTION
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.64 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$302.28
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$297.88
|
| Rate for Payer: Heritage Provider Network Senior |
$297.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$330.00
|
|
|
HC CAVERNOSGRAPHY INJECTION
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$302.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$330.00
|
| 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 |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$286.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.00
|
| Rate for Payer: Dignity Health Senior |
$374.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$272.36
|
| Rate for Payer: Heritage Provider Network Senior |
$272.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$212.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.00
|
| Rate for Payer: Multiplan Commercial |
$330.00
|
| 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 |
$374.00
|
| Rate for Payer: Vantage Medical Group Senior |
$374.00
|
|
|
HC CBC W DIFFERENTIAL
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Adventist Health Commercial |
$19.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.01
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.02
|
| Rate for Payer: Heritage Provider Network Senior |
$67.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$74.25
|
|
|
HC CBC W DIFFERENTIAL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.15
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC WITHOUT DIFFERENTIAL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.88
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.79
|
| Rate for Payer: Heritage Provider Network Senior |
$73.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
|
|
HC CBC WITHOUT DIFFERENTIAL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.15
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC WO DIFFERENTIAL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$18.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.15
|
| Rate for Payer: Blue Shield of California Commercial |
$50.53
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$12.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.47
|
| Rate for Payer: TriValley Medical Group Senior |
$6.47
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC WO DIFFERENTIAL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$81.75 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$74.88
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$73.79
|
| Rate for Payer: Heritage Provider Network Senior |
$73.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.25
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
|
|
HC CBC W WBC AUTO DIFF
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900910092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$65.09 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$22.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.09
|
| Rate for Payer: Blue Shield of California Commercial |
$60.71
|
| Rate for Payer: Blue Shield of California EPN |
$47.46
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Senior |
$7.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$7.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Senior |
$9.90
|
| Rate for Payer: Humana Medicare |
$7.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$14.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.79
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7.77
|
| Rate for Payer: TriValley Medical Group Senior |
$7.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$8.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
|
|
HC CBC W WBC AUTO DIFF
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900910092
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
