|
HC AMNIOCENTESIS DIAGNOSTIC ADDL FETUS
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
910400081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$213.22 |
| Max. Negotiated Rate |
$883.50 |
| Rate for Payer: Adventist Health Commercial |
$235.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$758.63
|
| Rate for Payer: Cash Price |
$530.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$797.51
|
| Rate for Payer: Heritage Provider Network Senior |
$797.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$213.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.50
|
| Rate for Payer: Multiplan Commercial |
$883.50
|
|
|
HC AMNIOCENTESIS THERAPEUTIC
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$982.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$969.90
|
| Rate for Payer: Blue Shield of California EPN |
$775.92
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,033.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$391.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$984.21
|
| Rate for Payer: Heritage Provider Network Senior |
$984.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$758.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$795.00
|
| Rate for Payer: TriValley Medical Group Senior |
$795.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$795.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$795.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC AMNIOCENTESIS THERAPEUTIC
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$1,192.50 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,023.96
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
|
|
HC AMNIOCENTESIS THERAPEUTIC ADDL FETUS
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$982.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$969.90
|
| Rate for Payer: Blue Shield of California EPN |
$775.92
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,033.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$391.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$984.21
|
| Rate for Payer: Heritage Provider Network Senior |
$984.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$758.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$795.00
|
| Rate for Payer: TriValley Medical Group Senior |
$795.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$795.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$795.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC AMNIOCENTESIS THERAPEUTIC ADDL FETUS
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
910400083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$287.79 |
| Max. Negotiated Rate |
$1,192.50 |
| Rate for Payer: Adventist Health Commercial |
$318.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,023.96
|
| Rate for Payer: Cash Price |
$715.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.43
|
| Rate for Payer: Heritage Provider Network Senior |
$1,076.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.50
|
| Rate for Payer: Multiplan Commercial |
$1,192.50
|
|
|
HC AMNIOTIC FLUID SCA
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 82143
|
| Hospital Charge Code |
900910277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$180.32
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$189.56
|
| Rate for Payer: Heritage Provider Network Senior |
$189.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
|
|
HC AMNIOTIC FLUID SCA
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 82143
|
| Hospital Charge Code |
900910277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$65.26 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$173.04
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$17.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.26
|
| Rate for Payer: Blue Shield of California Commercial |
$55.35
|
| Rate for Payer: Blue Shield of California Commercial |
$55.35
|
| Rate for Payer: Blue Shield of California EPN |
$44.40
|
| Rate for Payer: Blue Shield of California EPN |
$44.40
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$182.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$18.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$9.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$173.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.95
|
| Rate for Payer: Heritage Provider Network Senior |
$173.32
|
| Rate for Payer: Heritage Provider Network Senior |
$17.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$133.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$13.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.35
|
| Rate for Payer: TriValley Medical Group Commercial |
$9.35
|
| Rate for Payer: TriValley Medical Group Senior |
$9.35
|
| Rate for Payer: TriValley Medical Group Senior |
$9.35
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$10.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$10.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.29
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9.35
|
|
|
HC AMP FING/THUMB PRI/SEC SING
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
900501081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,465.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,895.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,508.22
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,903.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,394.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC AMP FING/THUMB PRI/SEC SING
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
900501081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,569.56
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
|
|
HC AMPHETAMINES CONF & ID
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900910520
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$221.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$269.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.59
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$233.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$305.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$253.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$305.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$184.46
|
| Rate for Payer: Heritage Provider Network Senior |
$184.46
|
| Rate for Payer: Heritage Provider Network Senior |
$222.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$142.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$251.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$208.60
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$179.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$149.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$149.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$179.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.15
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$305.15
|
|
|
HC AMPHETAMINES CONF & ID
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900910520
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$269.25 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$231.20
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.04
|
| Rate for Payer: Heritage Provider Network Senior |
$243.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.75
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
|
|
HC AMPICILLIN E TEST
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912448
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10.51
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$52.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.41
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California Commercial |
$23.16
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Blue Shield of California EPN |
$18.57
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$55.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.03
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$4.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$52.62
|
| Rate for Payer: Heritage Provider Network Senior |
$10.52
|
| Rate for Payer: Heritage Provider Network Senior |
$52.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$8.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$40.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: TriValley Medical Group Senior |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC AMPICILLIN E TEST
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912448
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$54.74
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Senior |
$57.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.25
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
|
|
HC AMPLATZER PLUG
|
Facility
|
OP
|
$3,120.00
|
|
| Hospital Charge Code |
909020031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,928.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,716.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,340.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,254.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,254.24
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,435.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,652.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,996.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,444.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,444.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,560.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,560.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,560.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,184.00
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,127.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,033.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,652.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,652.00
|
|
|
HC AMPLATZER PLUG
|
Facility
|
IP
|
$3,120.00
|
|
| Hospital Charge Code |
909020031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,009.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,254.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,254.24
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,435.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,684.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,444.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,444.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,560.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,560.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,560.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,340.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,127.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,033.03
|
|
|
HC AMPLATZ MICRO SNARE
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.22 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,001.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$810.32
|
| Rate for Payer: Blue Shield of California Commercial |
$988.20
|
| Rate for Payer: Blue Shield of California EPN |
$790.56
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,053.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$955.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,002.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,002.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$772.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$810.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$810.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC AMPLATZ MICRO SNARE
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.22 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,043.28
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,096.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,096.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
|
|
HC AMPLATZ RENAL DILATOR SET
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$389.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$535.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$346.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$472.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$253.26
|
| Rate for Payer: Blue Shield of California EPN |
$253.26
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$289.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$535.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$535.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$291.69
|
| Rate for Payer: Heritage Provider Network Senior |
$291.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$208.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$535.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$535.50
|
| Rate for Payer: Vantage Medical Group Senior |
$535.50
|
|
|
HC AMPLATZ RENAL DILATOR SET
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$126.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$405.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$253.26
|
| Rate for Payer: Blue Shield of California EPN |
$253.26
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$289.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$291.69
|
| Rate for Payer: Heritage Provider Network Senior |
$291.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$472.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$227.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$208.59
|
|
|
HC AMPLATZ SNARE
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.61 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$521.64
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$548.37
|
| Rate for Payer: Heritage Provider Network Senior |
$548.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
|
|
HC AMPLATZ SNARE
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909081269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.61 |
| Max. Negotiated Rate |
$688.50 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$500.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$688.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$445.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$607.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$405.16
|
| Rate for Payer: Blue Shield of California Commercial |
$494.10
|
| Rate for Payer: Blue Shield of California EPN |
$395.28
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$526.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$688.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$688.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$688.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$501.39
|
| Rate for Payer: Heritage Provider Network Senior |
$501.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$386.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$567.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$405.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$405.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$688.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$688.50
|
| Rate for Payer: Vantage Medical Group Senior |
$688.50
|
|
|
HC AMPLATZ THROMBECTOMY 120 CM
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,391.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$868.32
|
| Rate for Payer: Blue Shield of California EPN |
$868.32
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$993.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,000.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,000.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,080.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,080.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$780.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$715.18
|
|
|
HC AMPLATZ THROMBECTOMY 120 CM
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,334.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,188.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,620.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$868.32
|
| Rate for Payer: Blue Shield of California EPN |
$868.32
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$993.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,836.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,836.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,382.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,000.08
|
| Rate for Payer: Heritage Provider Network Senior |
$1,000.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,080.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,080.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,512.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$780.41
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$715.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,836.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,836.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,836.00
|
|
|
HC AMPLATZ THROMBECTOMY 50 CM
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$13,770.00 |
| Rate for Payer: Adventist Health Commercial |
$264.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$815.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$726.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,770.00
|
| Rate for Payer: Blue Shield of California Commercial |
$530.64
|
| Rate for Payer: Blue Shield of California EPN |
$530.64
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$607.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,122.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,122.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$844.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$611.16
|
| Rate for Payer: Heritage Provider Network Senior |
$611.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$660.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$660.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$924.00
|
| Rate for Payer: Multiplan Commercial |
$990.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$476.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$437.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,122.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,122.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,122.00
|
|
|
HC AMPLATZ THROMBECTOMY 50 CM
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$13,808.00 |
| Rate for Payer: Adventist Health Commercial |
$264.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$530.64
|
| Rate for Payer: Blue Shield of California EPN |
$530.64
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$607.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$611.16
|
| Rate for Payer: Heritage Provider Network Senior |
$611.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$660.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$660.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$660.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.00
|
| Rate for Payer: Multiplan Commercial |
$990.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$476.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$437.05
|
|
