|
HC AQUATIC THER W/EXER 15 MIN PT
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
905103142
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.40
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$213.26
|
| Rate for Payer: Heritage Provider Network Senior |
$213.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
905103142
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$216.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$267.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$173.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$236.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$204.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$267.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$267.75
|
| Rate for Payer: Dignity Health Senior |
$267.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$194.98
|
| Rate for Payer: Heritage Provider Network Senior |
$194.98
|
| Rate for Payer: IEHP Medi-Cal |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$151.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.75
|
| Rate for Payer: Multiplan Commercial |
$236.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$267.75
|
| Rate for Payer: Vantage Medical Group Senior |
$267.75
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT COMM MCARE
|
Facility
OP
|
$305.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900417113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$64.26
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$209.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$198.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Dignity Health Senior |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$188.80
|
| Rate for Payer: Heritage Provider Network Senior |
$188.80
|
| Rate for Payer: IEHP Medi-Cal |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$147.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.25
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC AQUATIC THER W/EXER 15 MIN PT COMM MCARE
|
Facility
IP
|
$305.00
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
900417113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$228.75 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$209.54
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$206.48
|
| Rate for Payer: Heritage Provider Network Senior |
$206.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.25
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
|
|
HC ARCH AORTA
|
Facility
OP
|
$6,021.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$271.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,204.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,136.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$2,709.45
|
| Rate for Payer: Cash Price |
$2,709.45
|
| Rate for Payer: Cash Price |
$2,709.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,913.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,727.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$271.22
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,089.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$4,515.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ARCH AORTA
|
Facility
OP
|
$9,643.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
906820219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$271.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,928.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,624.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$4,339.35
|
| Rate for Payer: Cash Price |
$4,339.35
|
| Rate for Payer: Cash Price |
$4,339.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,267.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,969.02
|
| Rate for Payer: Heritage Provider Network Senior |
$4,898.54
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$271.22
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,566.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,745.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,410.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$7,232.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,380.80
|
| Rate for Payer: TriValley Medical Group Senior |
$4,380.80
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC ARCH AORTA
|
Facility
IP
|
$6,021.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
909020144
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,089.80 |
| Max. Negotiated Rate |
$4,515.75 |
| Rate for Payer: Adventist Health Commercial |
$1,204.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,136.43
|
| Rate for Payer: Cash Price |
$2,709.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,076.22
|
| Rate for Payer: Heritage Provider Network Senior |
$4,076.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,089.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.25
|
| Rate for Payer: Multiplan Commercial |
$4,515.75
|
|
|
HC ARCH AORTA
|
Facility
IP
|
$9,643.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
906820219
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,745.38 |
| Max. Negotiated Rate |
$7,232.25 |
| Rate for Payer: Adventist Health Commercial |
$1,928.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,624.74
|
| Rate for Payer: Cash Price |
$4,339.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,528.31
|
| Rate for Payer: Heritage Provider Network Senior |
$6,528.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,745.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,410.75
|
| Rate for Payer: Multiplan Commercial |
$7,232.25
|
|
|
HC ARGON, THROMBEC CATH
|
Facility
OP
|
$2,827.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$565.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,357.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,942.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,403.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,555.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,755.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,659.74
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,300.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,403.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,403.38
|
| Rate for Payer: Dignity Health Senior |
$2,403.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,809.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,309.13
|
| Rate for Payer: Heritage Provider Network Senior |
$1,309.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,413.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.88
|
| Rate for Payer: Multiplan Commercial |
$2,120.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,030.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$944.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,403.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2,403.38
|
|
|
HC ARGON, THROMBEC CATH
|
Facility
IP
|
$2,827.50
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909020127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$565.50
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,357.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,942.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cash Price |
$1,272.38
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,300.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,526.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,914.22
|
| Rate for Payer: Heritage Provider Network Senior |
$1,914.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,413.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,413.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$706.88
|
| Rate for Payer: Multiplan Commercial |
$2,120.62
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,030.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$944.67
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
OP
|
$776.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
906820179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$533.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$426.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$582.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$504.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$659.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$659.60
|
| Rate for Payer: Dignity Health Senior |
$659.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$480.34
|
| Rate for Payer: Heritage Provider Network Senior |
$480.34
|
| Rate for Payer: IEHP Medi-Cal |
$13.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$374.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$659.60
|
| Rate for Payer: Vantage Medical Group Senior |
$659.60
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.43 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,011.26
|
| Rate for Payer: Cash Price |
$662.40
|
| 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 Medi-Cal |
$266.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.00
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
909081322
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,011.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$809.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$956.80
|
| 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 |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$911.17
|
| Rate for Payer: Heritage Provider Network Senior |
$911.17
|
| Rate for Payer: IEHP Medi-Cal |
$13.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$709.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.43
|
| 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 |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,251.20
|
|
|
HC ARTER, EA ADDL, 2ND/3RD ORD
|
Facility
IP
|
$776.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
906820179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.46 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$533.11
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$525.35
|
| Rate for Payer: Heritage Provider Network Senior |
$525.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.00
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
IP
|
$3,145.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
909081319
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.24 |
| Max. Negotiated Rate |
$2,358.75 |
| Rate for Payer: Adventist Health Commercial |
$629.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,160.62
|
| Rate for Payer: Cash Price |
$1,415.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,129.16
|
| Rate for Payer: Heritage Provider Network Senior |
$2,129.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.25
|
| Rate for Payer: Multiplan Commercial |
$2,358.75
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
OP
|
$3,145.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
909081319
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$629.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,160.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,673.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,729.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,358.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,415.25
|
| Rate for Payer: Cash Price |
$1,415.25
|
| Rate for Payer: Cash Price |
$1,415.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,044.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,673.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,673.25
|
| Rate for Payer: Dignity Health Senior |
$2,673.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,946.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,946.76
|
| Rate for Payer: IEHP Medi-Cal |
$281.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,515.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$786.25
|
| Rate for Payer: Multiplan Commercial |
$2,358.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,673.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,673.25
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
OP
|
$2,030.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
906820176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.10 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$406.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,394.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,725.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,116.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,522.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,319.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,725.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,725.50
|
| Rate for Payer: Dignity Health Senior |
$1,725.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,256.57
|
| Rate for Payer: Heritage Provider Network Senior |
$1,256.57
|
| Rate for Payer: IEHP Medi-Cal |
$281.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$978.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.50
|
| Rate for Payer: Multiplan Commercial |
$1,522.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,725.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,725.50
|
|
|
HC ARTERIAL, 1ST ORDER CATH PL
|
Facility
IP
|
$2,030.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
906820176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.43 |
| Max. Negotiated Rate |
$1,522.50 |
| Rate for Payer: Adventist Health Commercial |
$406.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,394.61
|
| Rate for Payer: Cash Price |
$913.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,374.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,374.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.50
|
| Rate for Payer: Multiplan Commercial |
$1,522.50
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
906820177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$186.25 |
| Max. Negotiated Rate |
$771.75 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$706.92
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$696.63
|
| Rate for Payer: Heritage Provider Network Senior |
$696.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
IP
|
$2,725.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
909081320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$493.22 |
| Max. Negotiated Rate |
$2,043.75 |
| Rate for Payer: Adventist Health Commercial |
$545.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,872.08
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,844.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,844.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.25
|
| Rate for Payer: Multiplan Commercial |
$2,043.75
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
OP
|
$2,725.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
909081320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$545.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,872.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,316.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,498.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,043.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cash Price |
$1,226.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,771.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,316.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,316.25
|
| Rate for Payer: Dignity Health Senior |
$2,316.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,686.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,686.78
|
| Rate for Payer: IEHP Medi-Cal |
$68.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,313.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.25
|
| Rate for Payer: Multiplan Commercial |
$2,043.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,316.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,316.25
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
906820177
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.53 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$706.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$874.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$565.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$771.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$668.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$874.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.65
|
| Rate for Payer: Dignity Health Senior |
$874.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$636.95
|
| Rate for Payer: Heritage Provider Network Senior |
$636.95
|
| Rate for Payer: IEHP Medi-Cal |
$68.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$495.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.25
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.65
|
| Rate for Payer: Vantage Medical Group Senior |
$874.65
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
IP
|
$1,106.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
906820178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.19 |
| Max. Negotiated Rate |
$829.50 |
| Rate for Payer: Adventist Health Commercial |
$221.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$759.82
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$748.76
|
| Rate for Payer: Heritage Provider Network Senior |
$748.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.50
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
OP
|
$2,904.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
909081321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$410.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$580.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$6,699.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,995.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,468.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,597.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,178.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,689.75
|
| Rate for Payer: Blue Shield of California EPN |
$7,468.44
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,887.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,468.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,468.40
|
| Rate for Payer: Dignity Health Senior |
$2,468.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,797.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,797.58
|
| Rate for Payer: IEHP Medi-Cal |
$410.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,399.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$726.00
|
| Rate for Payer: Multiplan Commercial |
$2,178.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,040.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$874.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,468.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.40
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
IP
|
$2,904.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
909081321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Adventist Health Commercial |
$580.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,995.05
|
| Rate for Payer: Cash Price |
$1,306.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,966.01
|
| Rate for Payer: Heritage Provider Network Senior |
$1,966.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$525.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$726.00
|
| Rate for Payer: Multiplan Commercial |
$2,178.00
|
|
